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Medicare Joint Replacement Cuts: What Every Patient Needs to Know for 2027

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Medicare joint replacement cuts explained by an orthopedic surgeon shown with total hip and total knee replacement implant models
What You Need To Know
  • ●Proposed Medicare joint replacement surgery reimbursement cuts would lower surgeon payment for total hip and total knee replacement by roughly 20 percent starting in 2027.
  • ●The proposal follows an 8 percent reduction that took effect in 2026; adjusted for inflation, Medicare payment for knee replacement surgeons has fallen 56.9 percent since 2000.
  • ●Medicare coverage itself is not changing: hip and knee replacement procedures remain covered benefits, and patients keep the right to choose their own surgeon under the new hospital payment model that begins in 2028.
  • ●Patients considering surgery should not panic or delay needed care; the smartest next step is a candid conversation with a board-certified orthopaedic surgeon about timing and options for your joint replacement.

By Cory Calendine, MD · Updated September 11, 2026, Board-Certified Orthopedic Surgeon

The proposed Medicare joint replacement cuts have been all over the news, and my patients are asking about them at almost every visit. In July 2026, Medicare released a proposed rule that would reduce surgeon payment for total hip and total knee replacement by roughly 20 percent starting in 2027. That headline sounds alarming. So I want to walk you through what is changing, what is not, and what it means if you live in Franklin, Nashville, Columbia, or anywhere in Middle Tennessee and are thinking about joint replacement.

After more than twenty years in practice and 700+ joint replacements per year, I have watched Medicare revalue these procedures several times. This round is bigger than most. Here is the plain-language version I share with patients across the desk.

Medicare joint replacement cuts chart showing total knee and total hip replacement surgeon pay falling 84% and 82% since 1990

What Are the Medicare Joint Replacement Cuts Proposed for 2027?

The Medicare joint replacement cuts are part of the proposed 2027 Medicare Physician Fee Schedule, released by the Centers for Medicare and Medicaid Services (CMS) in July 2026. The rule would reduce surgeon payment for the two billing codes that cover total hip replacement (code 27130) and total knee replacement (code 27447) by about 20 percent.

This is a proposal, not a final rule. CMS accepted public comments through September 14, 2026, and the final rule is expected later this year. Many surgeons and advocacy groups, including the American Association of Hip and Knee Surgeons (AAHKS), have formally asked CMS to withdraw the reductions.

Do the Medicare joint replacement cuts follow earlier reductions?

Yes. An 8 percent reduction for joint replacement surgeons already took effect in 2026. The longer trend is even steeper.

A 2025 study in the Journal of Arthroplasty found that, after adjusting for inflation, Medicare surgeon payment fell 56.9 percent for total knee replacement and 54.3 percent for total hip replacement between 2000 and 2024. Those were the largest declines among all high-volume inpatient procedures studied.

Why is Medicare proposing to pay surgeons less?

The short answer is efficiency. Twenty years ago, most patients stayed in the hospital for several days after surgery, and the payment formula included those daily hospital visits. Today, most of my patients go home the same day or the next morning. CMS argues that since those inpatient visits rarely happen anymore, the payment should shrink to match.

Here is what that formula misses. The patient did not disappear; the work changed.

My team now manages recovery through phone calls, portal messages, wound photos, and medication adjustments. That daily attention keeps people out of the emergency room. Modern recovery is safer and faster for you, but it still takes real work to deliver.

Will Medicare Still Cover My Hip or Knee Replacement?

Yes. Nothing in these rules changes your Medicare coverage for hip or knee replacement. These procedures remain fully covered benefits when medically necessary. The proposed changes affect how much Medicare pays your surgeon and, separately, how it pays hospitals; they do not change your eligibility for surgery.

In fact, while surgeon payment is being cut, CMS finalized a 2.3 percent payment increase for hospitals in 2027. That widening gap between facility payment and physician payment is one of the main concerns raised by independent orthopaedic practices nationwide.

Medicare joint replacement cuts context: Medicare surgeon pay versus hospital and ASC facility pay across 35 years of surgery

What Is the New Mandatory Bundled Payment Model (CJR-X)?

Alongside the fee schedule proposal, CMS finalized a separate program called the Comprehensive Care for Joint Replacement Expanded model, or CJR-X. Starting January 1, 2028, most hospitals nationwide must participate. Under this model, the hospital becomes financially accountable for the full cost and quality of your care across a 90-day episode: the surgery, the hospital stay, and the first 90 days of recovery, including physical therapy.

Hospitals that keep costs below regional benchmarks while meeting quality targets earn bonus payments. Hospitals that overspend may owe money back. The earlier pilot version of this program ran from 2016 through 2024 and saved Medicare more than 100 million dollars while quality held steady.

For patients, two things matter most. You still choose your own surgeon and your own care team. And well-run bundled programs reward exactly what we already emphasize in my practice: careful patient preparation before surgery, coordinated recovery afterward, and fewer avoidable complications and readmissions.

How Could These Changes Affect Patients in Middle Tennessee?

The honest answer is that the biggest risk from the Medicare joint replacement cuts is access, not quality. Surgeons who lead national advocacy warn that continued cuts could push some practices to limit the Medicare patients they accept. That would mean longer wait times for seniors. Financial pressure can also push independent practices to merge into large hospital systems, which reduces choice over time.

Here in Williamson County and the greater Nashville area, we are fortunate. The Bone and Joint Institute of Tennessee in Franklin was built around coordinated joint replacement care, from pre-surgery education through outpatient surgery and structured recovery. It is exactly the model these new payment programs reward.

My commitment to patients from Franklin, Brentwood, Columbia, Spring Hill, and across Middle Tennessee has not changed. I continue to care for Medicare patients every week.

What Should You Do If You Are Considering Joint Replacement?

Do not make a medical decision based on a headline. The right time for joint replacement is driven by your symptoms, your imaging, and your goals, not by a payment rule. That said, I tell my patients three practical things right now.

  • Get evaluated sooner rather than later. If knee or hip arthritis limits your life, an evaluation gives you a baseline and a plan, even if surgery is years away. If access tightens in 2027 and 2028, patients already established with a surgeon will be in the best position.
  • Ask how your surgeon handles recovery. Under 90-day episode models, the quality of your first three months after surgery matters more than ever. Ask about pre-surgery education, same-day discharge protocols, and how the team monitors you at home.
  • Make your voice heard if you wish. Medicare policy responds to patients, not just physicians. Beneficiaries can share concerns about access to joint replacement care with their members of Congress.

The Medicare joint replacement cuts are a payment story, not a coverage story. In my practice, nonsurgical care always comes first when it is appropriate.

Injections, activity modification, and strengthening help many people delay or avoid surgery. When surgery is the right answer, my team will walk you through every step, and Medicare will still be there to cover it.

If joint pain is holding you back, I would be glad to see you. You can schedule an appointment with me online or call the Bone and Joint Institute of Tennessee at (615) 791-2630. We are located at 3000 Edward Curd Lane, Franklin, TN 37067.

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Watch: Why Medicare Is Cutting Joint Replacement Payment by 20 Percent

If you want the full detail behind the Medicare joint replacement cuts, this hour-long conversation is the best patient-accessible source I have found. Dr. Matthew Sloan interviews Dr. Maxwell Courtney, Division Chief of Adult Reconstruction at Rothman Orthopaedics and chair of the AAHKS advocacy committee, about why the cuts were proposed and what they could mean for access to care.

Episode 46 of The Joint Replacement Podcast with Matthew Sloan, MD, featuring Maxwell Courtney, MD. Published September 10, 2026. Shared for patient education; Dr. Calendine is not affiliated with this podcast.

Medical Disclaimer: This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Medicare payment policies described here reflect proposed and finalized rules as of September 2026 and may change. Always consult a qualified healthcare provider about your individual situation, and contact Medicare or your plan directly with coverage questions.

References

  1. Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies (Proposed Rule, CMS-1848-P). Federal Register. July 16, 2026. Federal Register
  2. Centers for Medicare & Medicaid Services. CMS Announces Nationwide Expansion of Proven Joint Replacement Program. CMS Newsroom. July 31, 2026. cms.gov
  3. Centers for Medicare & Medicaid Services. FY 2027 IPPS and LTCH PPS Final Rule (CMS-1849-F). Federal Register. 2026. Federal Register
  4. Palmer RC, Elmenawi KA, Hannon CP, Lieberman JR, Heckmann ND. Medicare Reimbursement for Primary Hip and Knee Arthroplasty Is Disproportionately Decreasing Relative to Other High-Volume Inpatient Procedures: Leader of the Pack. J Arthroplasty. 2025;40(9 Suppl 1):S105-S109. doi:10.1016/j.arth.2025.04.088
  5. American Association of Hip and Knee Surgeons. AAHKS Submits First CMS MPFS Comment Letter. August 28, 2026. aahks.org
  6. Sloan M, Courtney PM. Why Medicare Is Cutting Joint Replacement 20%. The Joint Replacement Podcast, Episode 46. September 10, 2026. YouTube

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FREQUENTLY ASKED QUESTIONS

Common Questions From Readers

When do the Medicare joint replacement changes take effect?
The proposed 20 percent surgeon payment reduction would begin January 1, 2027, if finalized in the 2027 Medicare Physician Fee Schedule. The mandatory hospital bundled payment program, CJR-X, begins January 1, 2028. An earlier 8 percent reduction already took effect in 2026. The 2027 proposal remained under review after the public comment period closed on September 14, 2026.
Yes. Hip and knee replacement remain covered Medicare benefits when medically necessary, and none of the proposed or finalized rules change patient coverage or eligibility. The changes affect how much Medicare pays surgeons and hospitals, not whether the surgery is covered. Patients also keep the right to choose their own surgeon under the new payment models.
Medicare argues that joint replacement has become more efficient. Most patients now go home the same day or next day, so the hospital visits once built into the payment formula rarely occur. Inflation-adjusted Medicare payment for knee replacement surgeons has already fallen 56.9 percent since 2000, and surgeon groups argue the formula fails to count modern remote follow-up work.
Patients concerned about access to joint replacement can contact their members of Congress, since lawmakers have asked CMS to pause the reductions. Anyone with significant hip or knee arthritis should also consider getting evaluated by an orthopaedic surgeon now to establish care and a treatment plan, rather than waiting to see how national access changes in 2027 and 2028.
Yes. Medicare covers total knee replacement in 2026 when a doctor documents medical necessity, typically after nonsurgical treatments such as medication, injections, or physical therapy have not provided enough relief. Medicare Part A covers inpatient hospital care, and Part B covers outpatient surgery and physician services, subject to standard deductibles and coinsurance.
Dr. Cory Calendine, MD, board-certified orthopedic surgeon specializing in hip and knee replacement at the Bone and Joint Institute of Tennessee in Franklin, TN, shown in a gray suit with glasses and a blue tie during a professional portrait session.

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About Cory Calendine, MD

Dr. Cory Calendine is a board-certified, fellowship-trained orthopedic surgeon specializing in hip and knee replacement at the Bone and Joint Institute of Tennessee in Franklin, TN. He performs more than 700 hip and knee replacement procedures annually and serves as a consultant to Stryker for the Mako® robotic platform.

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