Medicare rate for CPT 27130 in 2026
Medicare’s national 2026 allowed amount for CPT 27130 is $1,162.02 in a facility, from the CMS 2026 October release. That is the doctor’s fee for the service when it is performed in a hospital or other facility. CMS marks the office (non-facility) setting as not applicable for this code, so there is no separate office rate. The figure is a national amount before geographic adjustment. What a specific provider is actually paid depends on the Medicare locality they practice in.
Total hip replacement
The hospital figure is the doctor’s fee, not the hospital’s. It is what Medicare pays the doctor when the service is done inside a hospital. The hospital is paid its own amount. That amount comes from a different Medicare schedule: OPPS for hospital outpatient care (see the hospital outpatient payment rate lookup), the ASC schedule when an ambulatory surgery center performs the service (see the ambulatory surgical center fee schedule lookup), and MS-DRG for an inpatient stay (see the hospital inpatient payment rate lookup). This page does not show it.
Code name above: S2Reason’s own label. CMS’s CPT descriptor is AMA-licensed text and is not shown · Status A: Active, payable · Source: CMS 2026 October (RVU26D, non-QP conversion factor), effective 10/2026.
Medicare pays the hospital side as an outpatient procedure as well as an inpatient one, so the hospital's bill may be priced under either schedule.
What CPT 27130 means
Replacement of both the ball and the socket of the hip joint with artificial parts. It carries a 90-day global period.
How the $1,162.02 is built
Work RVU 19.11, practice-expense RVU 11.63 in a facility, malpractice RVU 4.05. Each is multiplied by its geographic index, added together, then multiplied by the 2026 conversion factor of $33.4009. With every index at 1.000 that gives $1,162.02 in a facility.
CMS marks the non-facility (office) setting as Not Applicable for 27130, so there is no separate office rate.
This is the allowed amount for one unit, before the 2% sequestration reduction and before any multiple-procedure reduction. It is what Medicare allows, not what a commercial carrier or an auto policy allows, and not what the provider billed. Current Procedural Terminology (CPT) is copyright 2019–2025 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.
What CPT 27130 pays in New Jersey
New Jersey has 2 Medicare localities, so there is no single New Jersey rate. In a facility the allowed amount runs from $1,236.41 to $1,273.58, a spread of 3.0% across the state.
| Locality | Facilitydoctor’s fee, not the hospital’s |
|---|---|
| Northern NJ | $1,273.58 |
| Rest Of New Jersey | $1,236.41 |
CPT 27130 by fee-schedule year, 2023 to 2026
A bill is priced under the schedule in force on its date of service, not the one in force when it is reviewed. Note that 2024 has two entries: Congress changed the conversion factor on 9 March 2024, so a January 2024 date of service and a June 2024 date of service price differently.
| Fee-schedule year | Conversion factor | Facilitydoctor’s fee, not the hospital’s |
|---|---|---|
| 2026 | $33.4009 | $1,162.02 |
| 2025 | $32.3465 | $1,259.25 |
| 2024 (Mar 9 to Dec 31) | $33.2875 | $1,285.90 |
| 2024 (Jan 1 to Mar 8) | $32.7442 | $1,264.91 |
| 2023 | $33.8872 | $1,300.93 |
National amounts, every geographic index at 1.000, so the year-to-year movement here is the fee schedule changing and not a change of location.
CPT 27130 in every state
The facility allowed amount in each state, highest locality to lowest. Where a state shows one figure it has a single Medicare locality.
| State | Highest | Lowest | Localities |
|---|---|---|---|
| Alaska | $1,445.67 | - | 1 |
| New York | $1,392.21 | $1,102.42 | 5 |
| Florida | $1,384.78 | $1,212.97 | 3 |
| Illinois | $1,343.61 | $1,204.38 | 4 |
| California | $1,341.16 | $1,147.39 | 29 |
| District of Columbia | $1,280.92 | - | 1 |
| New Jersey | $1,273.58 | $1,236.41 | 2 |
| Washington | $1,257.36 | $1,158.57 | 2 |
| Massachusetts | $1,248.67 | $1,165.36 | 2 |
| Michigan | $1,241.22 | $1,145.67 | 2 |
| Connecticut | $1,233.10 | - | 1 |
| Maryland | $1,232.65 | $1,161.97 | 2 |
| Pennsylvania | $1,215.54 | $1,122.72 | 2 |
| Texas | $1,215.27 | $1,117.45 | 8 |
| Georgia | $1,197.34 | $1,146.04 | 2 |
| Oregon | $1,180.72 | $1,120.29 | 2 |
| Rhode Island | $1,172.35 | - | 1 |
| West Virginia | $1,169.43 | - | 1 |
| Colorado | $1,164.91 | - | 1 |
| Puerto Rico | $1,164.26 | - | 1 |
| Virgin Islands | $1,164.26 | - | 1 |
| Montana | $1,161.75 | - | 1 |
| New Hampshire | $1,161.03 | - | 1 |
| Hawaii / Guam | $1,158.29 | - | 1 |
| Louisiana | $1,157.50 | $1,111.66 | 2 |
| New Mexico | $1,156.97 | - | 1 |
| Delaware | $1,146.88 | - | 1 |
| Missouri | $1,143.64 | $1,104.89 | 3 |
| Nevada | $1,139.82 | - | 1 |
| Arizona | $1,130.50 | - | 1 |
| Ohio | $1,129.30 | - | 1 |
| Wyoming | $1,126.85 | - | 1 |
| Utah | $1,124.91 | - | 1 |
| Virginia | $1,115.64 | - | 1 |
| South Carolina | $1,112.20 | - | 1 |
| Maine | $1,108.61 | $1,079.81 | 2 |
| Kentucky | $1,107.40 | - | 1 |
| Vermont | $1,091.31 | - | 1 |
| Oklahoma | $1,090.29 | - | 1 |
| North Carolina | $1,087.16 | - | 1 |
| North Dakota | $1,081.66 | - | 1 |
| Minnesota | $1,078.05 | - | 1 |
| Mississippi | $1,072.72 | - | 1 |
| South Dakota | $1,072.20 | - | 1 |
| Indiana | $1,064.13 | - | 1 |
| Tennessee | $1,064.04 | - | 1 |
| Idaho | $1,059.65 | - | 1 |
| Kansas | $1,057.63 | - | 1 |
| Alabama | $1,054.75 | - | 1 |
| Wisconsin | $1,052.09 | - | 1 |
| Nebraska | $1,047.97 | - | 1 |
| Iowa | $1,047.43 | - | 1 |
| Arkansas | $1,041.64 | - | 1 |
Checking a different code, state or year
The Medicare rate lookup prices all 17,000-plus codes in the Physician Fee Schedule for any state and any fee-schedule year from 2023 to 2026. Ambulance codes are priced separately on the ambulance fee schedule, because Medicare does not pay for ambulance transport under this schedule at all.
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Medicare rates are a benchmark, not an allowance. What a no-fault, workers’ compensation or commercial carrier owes for CPT 27130 is set by the fee schedule or policy that governs the claim, which is frequently a multiple of the figure above.
One code is one line of a bill.
Desk prices a whole case against the schedule that actually governs the claim, with every line cited to the document it came from. Fair Measure Billing Experts prepares and signs the report when you need someone else to write it.