2026 CMS rule changes affecting outpatient joint replacement

The site of service for hip and knee replacement has been quietly shifting for nearly a decade. CMS removed total knee replacement from the inpatient-only list in 2018, total hip in 2020, and since then a steady stream of regulatory updates has continued to push elective joint replacement toward outpatient settings. The 2026 rules represent the latest stage of that shift. This post covers what changed and what it means for patients.

ASC payment expanded again

The ambulatory surgery center (ASC) covered procedures list has continued to grow. As of the 2026 OPPS/ASC final rule, ASCs are reimbursed for total hip, total knee, and an increasing number of shoulder, spine, and complex foot and ankle procedures. Hospitals retain the option to perform these as outpatient procedures, but the payment structures are increasingly designed to encourage the lower-cost setting where medically appropriate.

For patients, this means more choice in where elective joint replacement happens. A healthy 60-year-old having a knee replacement can now reasonably be scheduled at an ASC, with same-day discharge, at a lower facility cost than a hospital outpatient department.

Practical implication: when scheduling an elective joint replacement, ask the surgeon whether ASC is an option for you, and what the differences in cost-sharing would be.

Bundled payment models have evolved

The Comprehensive Care for Joint Replacement (CJR) model, which began in 2016 in selected markets, transitioned in 2024 into a broader Medicare bundled-payment framework. In 2026, more hospitals are participating in bundled-payment arrangements covering the 30 or 90 days after surgery, which include surgery, the hospital or ASC stay, post-acute care (skilled nursing or home health), and readmissions for related complications.

What this means for patients:

The hospital has financial skin in your post-discharge recovery, which has driven investment in home health, physical therapy, and remote monitoring.
Many participating hospitals have moved away from routine skilled nursing facility discharge after joint replacement and toward home discharge with home physical therapy. Outcomes data has supported this shift for medically appropriate patients.
Post-discharge phone calls, remote monitoring, and follow-up coordination are now more common at participating sites.

Bundled payment does not change what you pay out of pocket directly — your cost-sharing is still based on your plan — but it changes how care is coordinated.

Same-day discharge is the default for appropriate patients

In 2026, the median hospital length of stay for primary total knee replacement at high-volume centers is now under one day, and many ASCs operate on a same-day discharge model exclusively. The evidence for same-day discharge is strong for medically appropriate patients:

Lower readmission rates
Lower infection rates
Higher patient satisfaction
Faster return to baseline function

“Medically appropriate” usually means: BMI under 40 (though some programs accept higher), stable cardiopulmonary status, no active opioid dependence, manageable diabetes, a supportive home environment, and the ability to manage stairs and mobility post-op. Programs that do same-day discharge effectively also have prehabilitation (preoperative education and physical conditioning), multimodal pain protocols with peripheral nerve blocks, and 24/7 phone access for the first 72 hours.

If you do not meet the criteria for ASC same-day surgery, hospital outpatient remains a strong option. Inpatient admission for total joint replacement is now reserved for patients with significant medical complexity.

Price transparency rules tightened in 2026

CMS price transparency rules became more enforceable in 2024 and 2025, with substantial penalties for noncompliance. In 2026, most hospitals have published machine-readable files with negotiated rates for orthopedic procedures, including:

Total knee replacement (CPT 27447)
Partial knee replacement (CPT 27446)
Total hip replacement (CPT 27130)
Shoulder replacement (CPT 23472)
Anterior cervical discectomy and fusion (CPT 22551)
Lumbar fusion (CPT 22612)

The data is messy. Codes are bundled inconsistently, payer names are inconsistent, and the “negotiated rate” does not always reflect what a specific patient will pay. But for the first time, patients with high-deductible plans can get a meaningful sense of cost variation between facilities.

Several third-party tools (Turquoise Health, Sunshine Health, others) index the published files and present them in a more usable form. For an elective procedure, looking at facility cost variation in your metro area is now a reasonable part of due diligence.

Implant pass-through changes

CMS has continued to refine the rules around how new device technology is reimbursed. The transitional pass-through payment program continues to apply to certain new orthopedic implants. The practical impact for patients is small — the financial mechanics happen between hospitals, manufacturers, and CMS — but the policy supports adoption of new technology in a way that does not push device costs onto patients directly.

For most primary joint replacements in 2026, implant choice is largely commoditized. The major manufacturers’ implants have similar registry outcomes. The exception is revision surgery and complex primary cases (significant deformity, prior osteotomy), where implant choice matters more.

Telehealth follow-up is now standard

Postoperative follow-up visits for joint replacement can now be conducted by telehealth in most plans, including Medicare. The first postoperative visit is often in-person (incision check, suture or staple removal), but subsequent follow-ups at 6 weeks, 3 months, and 6 months can frequently be done by video.

For patients who traveled to a high-volume center for surgery, this matters. The follow-up burden of driving back for routine visits is often the limiting factor in choosing a center. Telehealth follow-up makes regional centers more accessible.

Ask the surgery practice what their telehealth follow-up policy looks like.

What this means for patients

If you are scheduling an elective joint replacement in 2026, the practical changes are:

Site of service is more flexible. ASCs are now a realistic option for medically appropriate patients, often at lower cost.
Same-day discharge is normal. If you are healthy and meet criteria, you should expect to go home the same day.
Bundled payment shapes the post-discharge experience. Hospitals participating in bundled models tend to have better-coordinated home recovery support.
Price transparency is real, if imperfect. Comparing facility costs is now possible.
Telehealth follow-up is standard. Regional centers are more accessible.

The CMS Hospital Outpatient PPS final rule is the source for current site-of-service rules. The Care Compare site has hospital-level data on complication and readmission rates for joint replacement.

What this means for patients searching orthopedic.tel

A 2026 elective hip or knee replacement is a different operation than a 2016 one. The most common path is: prehabilitation visit, surgery at an ASC or hospital outpatient department, same-day discharge home, home health or outpatient physical therapy starting within 24-48 hours, telehealth follow-up. This pathway works for most patients who would have spent 3-5 days in the hospital a decade ago.

If you are being told you need an inpatient stay for elective joint replacement and you are otherwise healthy, ask why. The answer may be reasonable. It also may reflect an outdated default.

Find an orthopedic clinic near you and ask about ASC and same-day discharge options.

This post was drafted by AI and reviewed by our editorial team. Last updated 2026-05-28.