Question 1

Does Medicare cover hip fracture surgery?

Accepted Answer

Yes. Medicare Part A covers the inpatient hospitalization for hip fracture repair (CPT 27236 for ORIF), including surgery, nursing care, and ancillary services. The 2026 Part A deductible is $1,736 for the first 60 days. After 60 days, daily coinsurance applies. Nearly all hip fracture repairs require inpatient admission. Medicare also covers medically necessary post-acute care in a skilled nursing facility (SNF) after a qualifying 3-day inpatient stay.

Question 2

Does Medicare cover rehabilitation after hip fracture repair?

Accepted Answer

Yes, with conditions. After a qualifying inpatient stay of at least 3 consecutive days, Medicare Part A covers up to 100 days in a skilled nursing facility (SNF) for rehabilitation. The first 20 days are fully covered; days 21–100 require a $217/day coinsurance in 2026 (covered by Medigap Plan G). After 100 days, Medicare SNF coverage ends. Physical therapy (Part B) is also covered on an outpatient basis after discharge, subject to the 20% coinsurance.

Question 3

What is the out-of-pocket cost for hip fracture surgery hospitalization under Medicare?

Accepted Answer

The 2026 Part A deductible is $1,736 for a hospital stay of 1–60 days. This is a per-benefit-period deductible (roughly per hospitalization), not an annual deductible. If you are readmitted within 60 days of discharge, you do not pay the deductible again. Days 61–90 cost $434/day in coinsurance. Without Medigap, a longer hospital stay can be very expensive. Medigap Plan G covers the $1,736 deductible, all daily coinsurance, and SNF days 21–100.

Question 4

Why does this calculator show a different amount than Medicare.gov's cost estimate?

Accepted Answer

This calculator may show a higher number than Medicare.gov's "Patient Pays (average)" for several reasons: (1) Deductible timing — this calculator applies the $283 Part B annual deductible if it has not yet been met; Medicare.gov's average assumes many patients have already satisfied theirs. (2) Anesthesia — Medicare.gov's estimate covers the facility fee and surgeon only; anesthesia is billed separately and is included in this calculator. (3) Location adjustment — surgeon fees are adjusted by your region's Geographic Practice Cost Index (GPCI); in high-cost cities like Seattle or New York, surgeon fees run 30–50% above the national rate. Facility fees (HOPD and ASC) are nationally fixed by CMS and should match Medicare.gov exactly. (4) Patient mix — Medicare.gov's "Patient Pays" average includes Medigap enrollees who pay $0 coinsurance, which pulls the reported average below what uninsured Original Medicare patients typically pay.

Cost Component	Medicare-Approved Amount	Your Share (20%)
Surgeon Fee — Hip Fracture Repair (CPT 27236)	$1,089	$218
Hospital Outpatient (HOPD) Facility Fee	$7,413	$1,483
Ambulatory Surgery Center (ASC) Facility Fee	$4,881	$976
Inpatient Hospital (DRG 481) — Medicare Pays	$15,241	$1,736 Part A deductible
Anesthesia (estimated)	$800–$1,400	20% of approved

Medicare Hip Fracture Repair Cost 2026 | Out-of-Pocket Estimator

2026 Medicare Cost Summary — Hip Fracture Repair (CPT 27236)

What Medicare Pays

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