Hip replacement after a hip fracture cost — Medicare payment benchmark

Estimated Medicare base payment

$15,410

Hip replacement after a hip fracture, no major complication — MS-DRG 522, relative weight 2.1177

Operating $14,300 + capital $1,110. national unadjusted — no wage index applied.

Wage-index method: none — national unadjusted benchmark. This is a national figure; a specific hospital's Medicare payment varies with its wage index and the adjustments below.

This is one of four different numbers. They are not interchangeable.

What this figure deliberately leaves out

• Indirect medical education — would need the hospital's resident-to-bed ratio.
• Disproportionate share / uncompensated care — would need the hospital's DSH percentage and CMS uncompensated-care allocation.
• Cost outlier — would need the hospital's cost-to-charge ratio and the case's charges.
• New technology add-on — would need the specific technology used in the case.
• Low-volume / rural adjustments — would need the hospital's volume and geographic status.

A specific hospital's Medicare payment can sit meaningfully above this national figure because of those adjustments. It is a benchmark, not a quote.

Other situations

• Hip replacement after a hip fracture, no major complication — shown above
• Hip replacement after a hip fracture, with major complication or comorbidity

Where to go next

• Find and verify an orthopaedic surgeon — the hospital and surgeon you choose change what is actually billed
• What your plan will cover — this benchmark is a Medicare payment, not your out-of-pocket cost
• How this DRG is adjudicated — the same MS-DRG drives how the claim is paid or denied
• The same benchmark on hipreplacement — DRG 469/470 cover hip and knee together
• The same benchmark on kneereplacement — DRG 469/470 cover hip and knee together

Source: CMS IPPS FY 2026 Final Rule (CMS-1833-F), 90 FR 36536, published 2025-08-04; DRG weight from CMS IPPS FY 2026. Applies to 2025-10-01 to 2026-09-30. Rates apply to IQR-participating, meaningful EHR user, wage index > 1. Read the rule.