Yes, Medicare covers total knee replacement surgery when it is deemed medically necessary. This is one of the most common surgeries performed on Medicare beneficiaries. Coverage falls under Medicare Part A (hospital stay) and Part B (surgeon and outpatient care).
Table of Contents
What Is Covered
- The surgical procedure (surgeon fees covered under Part B)
- Hospital stay — typically 1 to 3 days (covered under Part A)
- Anesthesia
- Implant (prosthetic knee components)
- Inpatient physical therapy during hospital stay
- Short-term skilled nursing facility stay if needed after discharge
- Outpatient physical therapy after discharge (Part B, with cost-sharing)
What You Will Pay
| Part A inpatient deductible | $1,736 per benefit period in 2026 |
| Days 1–60 in hospital | $0 coinsurance after deductible |
| Surgeon fee (Part B) | 20% after $240 Part B deductible |
| Outpatient PT | 20% per visit after deductible |
Medical Necessity Requirements
Medicare requires documentation that conservative treatments have been tried first. Your doctor must show that you have the following:
- Significant knee pain that limits daily activities
- Tried non-surgical treatments (physical therapy, anti-inflammatory medications, injections)
- X-ray evidence of severe joint damage
Recovery and Rehabilitation Coverage
After surgery, Medicare covers short-term inpatient rehab at a skilled nursing facility (SNF) if you had a qualifying 3-night hospital inpatient stay. Medicare Part B covers ongoing outpatient physical therapy, though you’ll pay 20% per session.
Frequently Asked Questions
Does Medicare cover both knees?
Yes, Medicare will cover surgery on both knees, though bilateral same-day surgery may require additional justification. Most surgeons recommend spacing the procedures at least 3 months apart.
What about minimally invasive or robotic-assisted surgery?
Medicare covers the underlying procedure regardless of technique but may not separately reimburse for robotic assistance if it significantly increases the cost without an established additional benefit. Confirm with your surgeon and hospital.
