Medicare Now Covers Outpatient Total Joint Replacement Surgery

Beginning this year, Medicare will cover outpatient total joint replacement under the Center for Medicare & Medicaid Services’ (CMS) new Hospital Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Payment System Rule.

In the past, total joint surgeries have required extended stays in the hospital or a rehab facility while the patient recovers. Now, better anesthesia techniques, surgical techniques, and improvements in prosthetic implants have significantly reduced the recovery time after a joint replacement. This means that extensive hospital stays are no longer required for post-operative rehabilitation.

Find out what this new rule means for you, and if you are a candidate for outpatient joint replacement.


What does this new Medicare rule mean?

  • The new Medicare rule represents a recognition that patients often recover from surgery better in their own homes and that extensive hospital stays are no longer required for post-operative rehabilitation.
  • Hip and knee replacement surgeries were previously on the Inpatient-only list of procedures that typically require patients to stay in a hospital overnight after surgery. These surgeries are now classified as “outpatient,” meaning the patient is expected to stay in the hospital for less than 24 hours.
  • This gives patients more options in choosing the location, quality of care and the ability to save in the cost of their care.


What are the benefits of outpatient joint replacement?

  • Outpatient surgery has a lower infection rate.
  • Patients can rest easier at home in a comfortable setting as opposed to staying overnight in a hospital.
  • Outpatient surgery is more affordable for patients.
  • Learn more about the benefits of outpatient joint replacement.


What types of outpatient joint surgeries are covered through Medicare?

  • Medicare now classifies total knee and total hip surgeries as outpatient surgeries.
  • The rule allows only total knee replacements to be done in a surgery center setting.
  • Total hip replacements can be done outpatient in a hospital, and soon total hip replacements will be allowed in a surgery center setting.


Am I a candidate for outpatient joint replacement?

  • Patient safety is the primary driver as to where surgery can be done. There are many contributing factors if a person can qualify as an outpatient joint patient.
  • Single health factor concerns such as having diabetes or being overweight are not an automatic disqualifier.
  • You can schedule an appointment online to see if you are a candidate.


Does ROC offer outpatient joint replacement surgery?

  • ROC can perform multiple types of outpatient joint replacement surgeries at the ROC Surgery Center.
  • Currently, patients using Medicare can only have outpatient total knee replacement surgeries performed at our surgery center.
  • Patients with commercial insurances like Aetna and Blue Cross can have other types of joint replacement surgeries done at our surgery center.


The outpatient joint replacement surgery has been optimized for the patient’s best surgical experience and patients who have their total joint surgeries done at ROC’s Surgery Center have a nurse by their bedside from start to finish through their surgery experience.

Learn more about outpatient joint replacement at Reno Orthopedic Clinic.