I'm interested in a robotic knee replacement surgery that my surgeon recommends for my specific anatomy. How does Medicare coverage work for this advanced procedure?

Question

Dutch VanHoesen · Accepted Answer

Original Medicare: Medicare premium $185/mo, $257 deductible + (20% of $20,000 to $40,000 + post care costs) 
$5-10K no max out of pocket.

Medigap Plan G: $200-225/mo+
Medicare premium $185/mo, $257 deductible is your max out of pocket for the year

Medicare Advantage: Medicare premium $185/mo (may be reduced by up to $174,70/mo) specialist copay $10-$45+ outpatient hospital copay $100-$300 + post op rehab $20-$40/visit maximum out of pocket could be less than $500. Max out of pocket $1000-$6700.

Gary Church · Answer

To answer this question: If it is medically necessary, Medicare will cover the surgery, but they may only cover the standard knee replacement. I would advise reaching out to Medicare for clarification.

Answered by Gary Church on June 13, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Steve and Sue Brauer · Answer

Again, if a physician deems the procedure medically necessary, Medicare will cover robotic knee surgery. You may still be responsible for some out of pocket costs depending on your coverage.

Daniel Brechin · Answer

Yes, a knee replacement will cover your Knee replacement.  Today generally it is a same day surgery.  You will have therapy following that.

Bill Wheeler · Answer

Medicare typically covers robotic knee replacement surgery, but medical necessity is the key factor. The procedure must be performed in a Medicare-approved facility, and you will be responsible for your plan's applicable deductibles, copayments, and coinsurance.

Answered by Bill Wheeler on September 15, 2025

Broker Licensed in KY & IN

Answered by Bill Wheeler Medicare Insurance Agent

Charise Karjala · Answer

What a great question. And in an area that I know a lot about because my background is in orthopedics. So the question is, how do we know that Medicare will pay for my robotic surgery that's been recommended for my knee surgery and my specific anatomy? Well, here's the deal. If your doctor says that it's required and he's a Medicare doctor, and he's done all of his data collection and he's got the health history, and you've had other surgeries or whatever the other indicators are that have to exist for this surgery to be a procedure based on your diagnosis code, then you're going to get that if you're in original Medicare with a secondary. There's no question about it. There's no insurance company that's going to come between you and your doctor that's going to say no. If your doctor has a good diagnosis, excellent record keeping, all of the MRIs and scans, and all of that kind of stuff that are all up to date, and you've been compliant in meeting your commitments in terms of injections and precursors to the surgery, you've lost weight, or you've stopped smoking, or all of the things that they expect you to do because they're spending a lot of money on you, you don't want to not be a candidate for whatever reason. You want to make sure that you are a good candidate for this. And if you do all of that right, then Medicare is not going to deny you. If it's an appropriate diagnosis with an appropriate procedure code that's approved by CMS, it will go seamlessly.

Now, if it's an experimental procedure, like I've had people come and think, "Oh sure, I have a bone spur and they have this new procedure of doing what is it called? Stem cells." Do you know how many people I know that spent $10,000, $15,000, $25,000 on stem cells that have no efficacy around bone spurs? It's unbelievable. So truly, if you've got a doctor that knows his onions and has done all of the data, and he's been taking care of you for quite a while, and he knows how to code Medicare and get paid by Medicare, you know that he does want to get paid for his work just like me and you, right? He's going to make sure that happens.

Now, we haven't talked about Medicare Advantage. Medicare Advantage may or may not pay for that. They may want to see other options being considered. They may not have a surgeon in their system that has access to that equipment. And so it may be a no-go. In which case, what you need to do is get with somebody like me, Charise Karjala in Palm Desert, California. I will run your background, see the analysis, and make a recommendation.

Sandra Teel · Answer

The answer to this question will depend upon the following.
1)  Whether Medicare approves of the robotic knee replacement surgery. If Medicare does NOT approve the surgery, they will not pay for it.  
2) If Medicare approves the surgery, then the type of insurance you have along with Medicare will determine the price you will pay for the surgery.

Ravi Natarajan · Answer

As long as it is medically necessary, your service provider should be able to get a prior authorization to help pay for this procedure.
Complete your profile so I can assist you
After that, schedule an Appointment.
Regards,
Ravi

Jennifer McDonnell · Answer

Most medical treatments that are considered 'experimental' are not covered by Medicare.
Check with your insurance prior to see if this will be covered.  If not, the expense will most likely be 100% your responsibility.  If you are a veteran, check with the VA to see if it is covered.

Ali Crouch · Answer

Medicare has a code for each procedure. Depending on which side of Medicare you choose—Original, with a supplement, or a Medicare Advantage plan—the amount you owe could look a little different. I would be more than happy to speak with anyone looking for this information and wanting to know what to expect. However, I cannot provide a definite answer without knowing your plan.

Answered by Ali Crouch on April 10, 2025

Broker Licensed in NE, AZ, CO & 11 other states

Answered by Ali Crouch Medicare Insurance Agent

Michael Ferraro · Answer

Medicare looks at is procedure covered. It doesn’t look at the technology that is used to do the procedure. As long as your dr says it is medically necessary and the drs office accepts Medicare assignment. There should be no issue

Answered by Michael Ferraro on July 30, 2025

Agent Licensed in NY

Answered by Michael Ferraro Medicare Insurance Agent

Chris Connell · Answer

This procedure would fall under B if it's "Outpatient". You would owe a $257 Deductible (if not already met for year) then 20% if you had original Medicare ONLY.

But if you (wisely) had a Medicare Supplement plan, it would cover your entire 20%. (You may have a $20 Co Pay).

If you had an Advantage plan, first it would have to get approved by the carrier's "Prior Authorization", then you would pay whatever Outpatient Surgery your policy has for such. Probably around $450 at an In Network facility

Steven Bleicher · Answer

You must ask your surgeon if this recommended procedure is covered by Medicare? If he pleads ignorance, he may not be trustworthy in this regard. When R&D (research & development) was happening (literally for years!), the suspicion had to be that there would be a process to get this experimental idea to be approved by both CMS & the CDC. If it has, great! If not, you’re paying for it.

Answered by Steven Bleicher on June 8, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

Robotic knee replacement surgery would be covered if medically necessary and performed at a Medicare-approved facility by a Medicare-approved physician. 

Medicare Part A covers inpatient surgeries, while Part B covers outpatient procedures, including those performed in a hospital setting. 

You may need to pay a deductible and coinsurance, depending on your plan and the type of procedure.

Carolyn Duncan · Answer

We need to consult Medicare.gov and see how they would or would not cover the robotic knee replacement surgery. I can explain how various policies will work based on the approval or denial of the service. Helping you through this process would be best practice by any agent.

Answered by Carolyn Duncan on July 16, 2025

Broker Licensed in FL, CA, CO & 12 other states

Answered by Carolyn Duncan Medicare Insurance Agent

Christopher Orr · Answer

If your Medicare approves the procedure, it will be covered on an outpatient basis. You will be responsible for a $257 deductible and 20% of the cost. If you have a supplemental plan, it will cover the 20%. If you opt for a Medicare Advantage plan, it will cover all costs, subject to your outpatient copay, which typically ranges from $100 to $300 for most Tennessee plans.

Answered by Christopher Orr on June 2, 2025

Broker Licensed in TN, KY, NC & VA

Answered by Christopher Orr Medicare Insurance Agent

Lloyd Griffin · Answer

The answer is not just Black & White there are many things to consider just a few are listed here in no specific order:
Cost Considerations
Inpatient or Outpatient
Medically necessary
Facility Medicare Approved 
Cost After the Surgery
A careful assessment of the whole process is needed.

Bob Callahan · Answer

Generally speaking, if it is deemed medically necessary by your physician, Medicare will cover it. How much you'd have to pay as well as whether pre-authorization is required, however, is dependent upon your plan (i.e. Medigap versus Med Advantage, etc...).. Medicare would cover the surgery, the actual robotic knee, and post-surgery rehab...

Answered by Bob Callahan on March 2, 2026

Broker Licensed in TX, CA, GA & 6 other states

Answered by Bob Callahan Medicare Insurance Agent

Lowana Richardson · Answer

The best answer is to ask your physician to see if he can get that approved. Your physician would know better than anyone else because that is what they do. There is a good possibility that it could get approved. Each case is different.

Answered by Lowana Richardson on May 19, 2026

Agent Licensed in HI, AZ & CA

Answered by Lowana Richardson Medicare Insurance Agent

Ted Heckel · Answer

Medicare would normally cover this as long as Medically necessary. The coverage is based on the procedure not the technology for this

Fred Manas · Answer

Yes, Medicare generally covers robotic knee replacement surgery if it's deemed medically necessary and performed at a Medicare-approved facility. The procedure is covered under Medicare Part A for inpatient procedures and Part B for outpatient procedures. However, it's crucial to ensure the surgeon is a participating Medicare provider, even if operating remotely, according to Far North Surgery. 
Elaboration:
Medical Necessity:
Medicare coverage is contingent on your doctor determining that the robotic knee replacement surgery is medically necessary for your specific condition. 
Medicare-Approved Facility:
The surgery must be performed at a facility that is certified by Medicare. 
Participating Provider:
The surgeon performing the robotic knee replacement, even if operating remotely, needs to be a participating Medicare provider. 
Part A and Part B Coverage:
If the surgery is inpatient, it's covered under Medicare Part A. If it's an outpatient procedure, it's covered under Part B. 
Out-of-Pocket Costs:
While Medicare will cover a portion of the costs, you'll still have out-of-pocket expenses like the Part B deductible and coinsurance. 
Medigap Plans:
If you have a Medigap plan, it may help with the out-of-pocket costs like coinsurance and the Part B deductible, according to Robotic Orthopaedic Institute. 
Robotic Surgery Specifics:
The robotic knee replacement surgery is not inherently a separate coverage category. It's a surgical technique that, if medically necessary, is covered under the same Medicare rules as traditional knee replacement surgery.

Vachik Chakhbazian · Answer

Medicare covers knee replacement surgery, including robotic-assisted procedures, if your doctor determines it's medically necessary.

Gary Henderson · Answer

Yes, Medicare generally covers robotic knee replacement if it's deemed medically necessary and performed at a Medicare-approved facility

Andrew Kramer · Answer

Medicare covers robotic knee replacement. It would be the same co-insurance or co-pays as regular knee replacement surgery.

Carol Thompson · Answer

That depends on your plan coverage- consult with your member’s services to of your plan to determine your coverage in the procedure.

Suzanne Lamperti · Answer

Unfortunately it looks like Meducare does not cover that procedure. I suggest if you have a Meducare Supplement,  see if it will cover the procedure.

Jennifer Kalbach · Answer

Do you have Medicare Advantage or a Medicare Supplement policy in addition to Part A & Part B? I highly recommend you speak to your carrier to ask them about possible out of pocket costs that you can incur.

Answered by Jennifer Kalbach on September 15, 2025

Agent Licensed in KY

Answered by Jennifer Kalbach Medicare Insurance Agent

Don Hansford · Answer

Medicare does cover this. Traditional Medicare would have a 20% coinsurance. If you have a Medicare Supplement, it would cover this 20% after you have satisfied the Part B deductible. If you are covered on a Medicare Advantage plan, check with the carrier as to the copay and whether the procedure might need to be pre-approved.

Answered by Don Hansford on October 7, 2025

Broker Licensed in TX

Answered by Don Hansford Medicare Insurance Agent

Sam Silva · Answer

Original Medicare (Part A and Part B) covers medically necessary knee replacement surgery, including the hospital stay (Part A) and outpatient services (Part B).

Robotic-assisted surgery is generally considered a type of minimally invasive surgery, which may offer benefits like smaller incisions and faster recovery, but the coverage would be the same as traditional knee replacement if it’s medically necessary for your condition.

Charles Borg · Answer

If it’s considered absolutely necessary, it might be covered. There would have to be a good reason why a regular knee replacement surgery wouldn’t work.

Robert Nunn · Answer

I would call customer service of your specific plan and ask them if it’s covered or call directly to Medicare and ask them as well also I would call doctors billing department and ask them as well

Tristan Gibbs · Answer

Your part B coverage will pay 80% of the cost of the surgery as well as the durable medical equipment. You may have additional coverage if you are enrolled in a Medicare Advantage or Medicare Supplement plan.

Answered by Tristan Gibbs on April 7, 2026

Broker Licensed in FL

Answered by Tristan Gibbs Medicare Insurance Agent

Otisha Newton · Answer

The important thing to know is that Medicare can cover robotic knee replacement, but your costs and coverage depend on your plan and the facility. The best way to be sure is to check your specific plan and confirm with your surgeon. If you want, I can help you review your plan, figure out costs, and make sure everything is set before your surgery—reach out to me anytime, and I’ll walk you through it.

Answered by Otisha Newton on November 20, 2025

Agent Licensed in AZ, AL, AR & 18 other states

Answered by Otisha Newton Medicare Insurance Agent

Thermon Holliday · Answer

Working with Medicare actually means, working with Insurance Carriers.  Depending on the type of Medicare plan you choose and are currently under your options will vary.  
Option #1. Supplemental insurance; provides the simpliest access to care regardless if tech level.

Option #2. Advantage coverage; would require approval for any and all procedures.  

Bottom-line, you have choices in the matter.

Ross Landon · Answer

That might be an overnight procedure & with most advantage plans surgery in a hospital would mean a co-pay per night of about $350 to maybe $500, depending upon your plan.   So if you have to stay a couple of days in the hospital, it’s still probably gonna be less than about $1000!  

If it is just same day surgery, it will be about that much co-pay for the single procedure itself. So still the cost is pretty reasonable for surgery. $350- $500.

John Weaver · Answer

Yes, 

Medicare covers robotic surgery when it is deemed medically necessary and performed in an approved facility. 

Part A covers inpatient procedures, while Part B covers outpatient ones, and you will likely be responsible for copayments or coinsurance.  Medicare Advantage (Part C) or Supplements may also cover the costs.

Ricky Gonzalez · Answer

Medicare does cover knee replacement surgery, including robotic-assisted procedures, as long as the surgery is considered medically necessary and performed at a Medicare-approved facility. 

The robotic component itself isn’t billed separately, so your coverage depends more on whether your surgeon and hospital accept your Medicare plan, and your out-of-pocket costs will vary depending on whether you have Original Medicare with a supplement or a Medicare Advantage plan.

Rob Baer · Answer

Knee surgery is normally considered and outpatient procedure, and therefore would fall under the Part B Medicare. It would then depend on the plan you had as to your portion of the cost.
Under original Medicare you would pay 20%, and if you had a Medicare Supplement the 20% would be covered and you would pay up to $283 for your portion of the Part B deductible if it has not already been met. 
If you are on a Medicare Advantage plan it would be the outpatient procedure copay which can vary on some plans based on if were performed at a hospital or Surgery Center as many carriers have separate fees based on where the surgery took place.

Glenda Martin · Answer

Robotic knee replacement surgery is a type of advanced surgical procedure that uses robotic technology to assist surgeons during the operation. Medicare coverage for this procedure can vary depending on several factors.

*Medicare Coverage:*
Medicare typically covers knee replacement surgeries, including robotic-assisted procedures, when deemed medically necessary. However, coverage specifics may differ based on the type of Medicare plan you have (Original Medicare, Medicare Advantage, etc.) and the particular procedure.

*Key Considerations:*

- *Medicare Part A*: Covers hospital stays, which would include the surgical procedure.
- *Medicare Part B*: Covers doctor services, outpatient care, and some preventive services.
- *Coinsurance and Deductibles*: You may still be responsible for out-of-pocket costs, such as coinsurance and deductibles.

*To Confirm Coverage:*

- *Contact Medicare Directly*: Reach out to Medicare to determine the specifics of your coverage.
- *Consult with Your Surgeon*: Discuss the procedure with your surgeon to understand the medical necessity and potential benefits.
- *Check with Your Medicare Plan*: If you have a Medicare Advantage plan, review your plan's coverage details.

Or contact me directly and I will be happy to assist you with your insurance coverage 

It's essential to verify coverage and costs with Medicare and your healthcare provider to ensure a smooth process.

Sarah Murphy · Answer

In general Medicare takes a look at robotic knee replaces like it does traditional knew replacements. However, like any medical procedure it must be deemed as medically necessary. Medicare Part A covers the inpatient stay while Part B covers outpatient services and doctor fees. If you have a Medicare supplemental plan than that might help with your deductibles, coinsurance, including your out of pocket costs. 

Confirm the details of your surgery with your surgeon's office, this will help with both Medicare Advantage and traditional Medicare with a supplement.

Artreanua Carr · Answer

Good Morning! Most procedures would have to be first of all medically necessary, but your cost, authorizations for an approval for the plan to pay etc would be based on the carrier and the plan you choose to be your plan. You are welcome to reach out to me to further discuss your options.

Answered by Artreanua Carr on March 25, 2026

Agent Licensed in NC, AR, FL & 8 other states

Answered by Artreanua Carr Medicare Insurance Agent

I'm interested in a robotic knee replacement surgery that my surgeon recommends for my specific anatomy. How does Medicare coverage work for this advanced procedure?

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I'm interested in a robotic knee replacement surgery that my surgeon recommends for my specific anatomy. How does Medicare coverage work for this advanced procedure?

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