This page is written for the owner, practice administrator or marketing lead of a shoulder or joint replacement practice. It sets out what Medicare pays the surgeon in 2026 for a total shoulder replacement, in which both the ball and the socket of the shoulder joint are replaced, what that becomes in your locality, and the payment rules that change the value of a single case.
All numbers come from the CMS 2026 physician fee schedule relative value file (October release) and the 2026 geographic index table in the same download. I applied the facility payment formula that CMS prints in the file’s readme.
I run a marketing agency for surgical practices. Knowing what a case pays is where I start when a practice asks whether a service line is worth promoting, and shoulder replacement is a service line many groups are growing.
When I reviewed the pages that rank for this procedure’s 2026 Medicare reimbursement, they were billing software, coding reference and medical billing company pages. The results I read showed the national payment and RVUs. None showed a locality-level payment, and none compared the shoulder with the hip and knee.
The 2026 national payment
The procedure carries 38.93 total RVUs in the facility setting. At the 2026 conversion factor of $33.4009, the national surgeon payment is $1,300.30.
| Component | RVUs | Dollars | Share |
|---|---|---|---|
| Physician work | 21.58 | $720.79 | 55.4% |
| Practice expense (facility) | 12.99 | $433.88 | 33.4% |
| Malpractice | 4.36 | $145.63 | 11.2% |
| Total | 38.93 | $1,300.30 | 100% |
For clinicians who qualify through an advanced alternative payment model, CMS publishes a version of the file with a $33.5675 conversion factor. That makes the payment $1,306.78, a difference of $6.49.
The procedure is facility only in the file, so there is no office rate.
The shoulder pays more than a hip or knee
Among the three primary joint replacements, the total shoulder has the highest physician work value in the 2026 file:
| 2026 national surgeon payment | Total shoulder | Total hip | Total knee |
|---|---|---|---|
| Work RVUs | 21.58 | 19.11 | 19.11 |
| Total RVUs | 38.93 | 34.79 | 34.71 |
| Payment | $1,300.30 | $1,162.02 | $1,159.35 |
A Medicare total shoulder pays the surgeon $140.95 more than a total knee nationally, about 12.2% more, and $138.28 more than a total hip. Most of the gap with the knee comes from physician work. The shoulder carries 2.47 more work RVUs, worth $82.50 at $33.4009. Another 1.41 practice expense RVUs add $47.10, and 0.34 malpractice RVUs add $11.36. Those three add up to the $140.95 difference, within a cent of rounding. For a practice deciding which joint to promote to Medicare-age patients, that is the professional-fee gap per case, before any difference in demand, competition or the cost to win a patient.
The hip and knee figures are on the total hip and total knee reimbursement pages.
What the payment is in 10 localities
Each of the 109 Medicare payment localities has its own index for work, practice expense and malpractice. The 2026 work index has a floor of 1.0, extended by Congress through January 1, 2027.
| Medicare locality | 2026 total shoulder surgeon payment |
|---|---|
| Arkansas (lowest) | $1,168.49 |
| Alabama | $1,182.86 |
| Rest of Texas | $1,264.04 |
| National | $1,300.30 |
| Houston | $1,357.78 |
| Los Angeles and Orange County | $1,360.32 |
| Suburban Chicago | $1,429.48 |
| Manhattan | $1,502.05 |
| San Jose area (San Benito County) | $1,503.79 |
| Miami | $1,540.75 |
| NYC suburbs and Long Island (highest outside Alaska) | $1,553.23 |
| Alaska (work index floor of 1.5) | $1,623.51 |
Between Arkansas and Long Island, the same shoulder case differs by $384.74, or 32.9%. In 61 of the 109 localities, the payment sits below the national amount.
The fee schedule amount is a starting point. Deductibles, coinsurance and adjustments outside this file all affect what is collected, and your remittance data is the final word for your practice.
What sits inside the fee
The procedure has a 90-day global period. CMS describes this in the file as major surgery with a one-day preoperative period and a 90-day postoperative period included in the fee schedule amount. Routine follow-up in those 90 days is not billed separately.
| Part of the global package | Share | National dollars |
|---|---|---|
| Preoperative | 10% | $130.03 |
| Intraoperative, including in-hospital post-op work | 69% | $897.20 |
| Postoperative office care after discharge | 21% | $273.06 |
These shares apply when care inside the global period is split between clinicians.
Rules that change the value of a case
The CMS row for this procedure sets the following:
- Multiple procedures on one day: standard rules. The highest-valued procedure is paid at 100% and others at 50%. A second procedure with this value would be paid $650.15 nationally.
- Bilateral: the 150% adjustment applies, with payment based on the lower of the actual charge or $1,950.45 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 payment and the 2026 rule
The hospital or surgery center is paid separately for the same case. Those rates are published in CMS addenda that carry an AMA license agreement, so they are not on this page.
The CY 2026 outpatient final rule in the Federal Register says CMS is “phasing out the IPO list over 3 years,” beginning with 285 mostly musculoskeletal services in 2026 (Federal Register, CMS-1834-FC). It also adds 276 procedures to the surgery center covered procedures list under revised criteria and 271 more that are leaving the inpatient only list. Whether a specific shoulder procedure is on either list for your site is a question for your coding team and the published addenda.
The facts side by side
The 2026 national Medicare surgeon payment for a total shoulder replacement is $1,300.30.
That is $140.95 more than a total knee and $138.28 more than a total hip.
It pays $1,168.49 in Arkansas and $1,553.23 on Long Island.
The fee includes 90 days of routine post-op care.
In one orthopedic practice I audited, 92% of Google Ads spend went to a campaign with zero appointments, and the appointment buttons led to a page without a form.
What those mean together for your practice is for you to work out.
If you would like a second view on what a shoulder case costs you to win in your market, book a 30-minute call. I will look at your site and your market before we talk.
Related pages
The patient-facing price side is on shoulder replacement cost and reverse vs anatomic shoulder replacement cost. For acquisition costs, see orthopedic patient acquisition cost.
How the numbers were built
I used the procedure’s work, facility practice expense and malpractice RVUs from the 2026 national relative value file, October release, and the work, practice expense and malpractice indices for all 109 localities from Addendum E in the same CMS download. For each locality, each RVU is multiplied by its index, the three results are added, and the sum is multiplied by $33.4009. That is the facility formula in the CMS readme. With every index at 1.0, the output equals the national amount, and the CMS physician fee schedule look-up tool will return the same figures.
Frequently asked questions
What does Medicare pay for a total shoulder replacement in 2026? The national surgeon payment is $1,300.30 in the facility setting, from 38.93 RVUs at $33.4009. At the alternative payment model conversion factor of $33.5675, it is $1,306.78.
Does a shoulder replacement pay more than a knee or hip replacement? Yes, on the surgeon’s fee. Nationally in 2026, the total shoulder pays $1,300.30, against $1,162.02 for a total hip and $1,159.35 for a total knee.
How much does the shoulder replacement payment vary by location? From $1,168.49 in Arkansas to $1,553.23 on Long Island across the lower 48, and $1,623.51 in Alaska.
Are follow-up visits included? Yes. Routine care in the 90-day global period is included in the fee.
Does this include what the hospital or surgery center is paid? No. It covers only the surgeon’s payment under the physician fee schedule.
