If you run or market a joint replacement practice, this page gives you the 2026 Medicare surgeon payment for a primary total hip replacement, what it becomes in your locality, and the payment rules that change what a single case is worth. I computed every number from the CMS 2026 physician fee schedule relative value file (October release) and its geographic index table, using the formula CMS prints in that file.
My work is marketing for surgical practices. The surgeon’s Medicare fee is one of the first numbers I want before planning spend on a joint replacement service line, because it shows what each Medicare case brings in on the professional side.
When I reviewed the pages that rank for this procedure’s Medicare reimbursement, they were mostly coding reference sites, billing software pages and billing company blogs. The results I read gave the national amount and RVUs, and none showed a locality-by-locality payment. One quoted a percentage change from 2025, which I could not check against a 2025 file, so I left it out.
The 2026 national figure
CMS gives a primary total hip replacement 34.79 total RVUs in the facility setting. At the 2026 conversion factor of $33.4009, the national surgeon payment is $1,162.02.
| Part of the fee | RVUs | Dollars | Share of total |
|---|---|---|---|
| Physician work | 19.11 | $638.29 | 54.9% |
| Practice expense (facility) | 11.63 | $388.45 | 33.4% |
| Malpractice | 4.05 | $135.27 | 11.6% |
| Total | 34.79 | $1,162.02 | 100% |
Clinicians who qualify through an advanced alternative payment model are paid from a separate version of the file with a conversion factor of $33.5675. For this procedure, that is $1,167.81, or $5.80 more per case.
There is no office rate. The file lists the procedure as facility only.
Hip and knee pay almost the same
The physician work value for a total hip and a total knee is identical at 19.11 RVUs. The difference comes from small gaps in practice expense and malpractice values:
| 2026 national surgeon payment | Total hip | Total knee |
|---|---|---|
| Total RVUs | 34.79 | 34.71 |
| Payment at $33.4009 | $1,162.02 | $1,159.35 |
| Difference | $2.67 more for the hip |
On the professional fee alone, a Medicare hip case and a Medicare knee case are worth almost exactly the same to the surgeon. Whatever separates the two service lines for your practice, it is not this number.
Because CMS sets the fee, a practice cannot raise its Medicare price for a hip case. What it can change is how many hip patients find it, call, get answered and reach a surgeon. That chain is the part marketing touches, and it is why I start with the fee: it tells me the most one Medicare case can return on the professional side before I look at what it costs to win.
The payment in 10 localities
Medicare pays a different amount in each of its 109 payment localities. CMS applies a geographic index to each of the three RVU components; in 2026 the work index has a floor of 1.0, extended by Congress through January 1, 2027.
| Locality | 2026 total hip surgeon payment |
|---|---|
| Arkansas (lowest) | $1,041.64 |
| Alabama | $1,054.75 |
| Rest of Texas | $1,129.08 |
| National | $1,162.02 |
| Los Angeles and Orange County | $1,213.82 |
| Houston | $1,215.27 |
| Suburban Chicago | $1,281.40 |
| Chicago | $1,343.61 |
| Manhattan | $1,345.07 |
| Miami | $1,384.78 |
| NYC suburbs and Long Island (highest outside Alaska) | $1,392.21 |
| Alaska (work index floor of 1.5) | $1,445.67 |
From Arkansas to Long Island, the same case moves by $350.58, or 33.7%. In 62 of the 109 localities, the surgeon receives less than the national amount.
The fee schedule amount is not the same as the deposit. Deductibles, coinsurance and adjustments outside this file all apply. Your own remittance data settles what your practice actually collects.
The 90-day global package
The procedure has a 90-day global period. CMS defines that in the file as a one-day preoperative period and a 90-day postoperative period included in the fee schedule amount. The file splits the package into preoperative, intraoperative and postoperative shares:
| Share of the global package | Percent | National dollars |
|---|---|---|
| Preoperative | 10% | $116.20 |
| Intraoperative (includes in-hospital post-op work) | 69% | $801.79 |
| Postoperative care in the office | 21% | $244.02 |
When a different clinician provides part of that care, these shares decide how the fee divides.
Indicators that change what one case pays
The CMS row for this procedure sets these rules:
- Same-day multiple procedures: standard adjustment. The highest-valued procedure is paid in full and the next ones at 50%. A second procedure with this value would be paid $581.01 nationally.
- Bilateral: the 150% rule applies. Both hips on the same day are paid at the lower of the actual charge or $1,743.03 at the national rate.
- Assistant at surgery: may be paid.
- Co-surgeons: could be paid with documentation of medical necessity.
- Team surgery: not permitted.
The facility side and the 2026 policy changes
The hospital or surgery center payment for the same case is separate, and much of it is set in CMS addenda that carry an AMA license agreement. I have not used those tables here.
The 2026 outpatient final rule in the Federal Register states that CMS is “phasing out the IPO list over 3 years,” starting with 285 mostly musculoskeletal services in 2026 (Federal Register, CMS-1834-FC). The rule also adds 276 procedures to the surgery center covered procedures list based on new criteria, and another 271 that are leaving the inpatient only list. The same rule names total knee and total hip replacement as device-intensive procedures in the surgery center setting.
I covered what that shift means for marketing in marketing total joint replacement in an ASC.
Side by side for an owner
The 2026 national Medicare surgeon payment for a total hip replacement is $1,162.02.
A total knee pays $1,159.35, a difference of $2.67.
The same hip case pays $1,041.64 in Arkansas and $1,392.21 on Long Island.
The fee includes 90 days of routine post-op visits.
In one orthopedic practice I audited, 92% of the Google Ads budget went to a campaign with zero appointments, and the appointment buttons opened a page with no form.
What those mean together for your practice is for you to work out.
To look at what a hip case costs you to win where you practice, book a 30-minute call. I will look at your site and your market before we talk.
Related pages
Patient-facing price ranges are on hip replacement cost. Marketing spend benchmarks are on orthopedic patient acquisition cost and orthopedic practice marketing cost.
Method
I took the procedure’s work, facility practice expense and malpractice RVUs from the 2026 national relative value file, October release, and the 2026 work, practice expense and malpractice indices for all 109 localities from Addendum E in the same download. Each locality payment is each RVU times its index, summed, times $33.4009, which is the facility formula printed in the CMS readme. With all indices at 1.0, the result equals the national figure above. The CMS physician fee schedule look-up tool will show the same amounts for any locality.
Frequently asked questions
What does Medicare pay a surgeon for a total hip replacement in 2026? $1,162.02 nationally in the facility setting, from 34.79 RVUs at a conversion factor of $33.4009. At the alternative payment model conversion factor of $33.5675, it is $1,167.81.
Does Medicare pay more for a hip replacement than a knee replacement? Slightly. In 2026 the national surgeon fee for a total hip is $1,162.02 and for a total knee $1,159.35, a $2.67 difference. The physician work value is the same for both.
Why does the hip replacement payment vary by state? Each of 109 Medicare localities has its own geographic indices for work, practice expense and malpractice. For this procedure the payment ranges from $1,041.64 in Arkansas to $1,392.21 on Long Island, and $1,445.67 in Alaska.
Are post-op visits paid separately? Not for routine care inside the 90-day global period. They are included in the fee.
Is the hospital or ASC payment included here? No. This page covers only the surgeon’s physician fee schedule payment.
