Question 1

Does Medicare cover knee arthroscopy?

Accepted Answer

Yes, with limitations. Medicare covers knee arthroscopy for medically necessary therapeutic procedures, such as partial meniscectomy (CPT 29881) for symptomatic meniscal tears confirmed by MRI. However, Medicare does not cover purely diagnostic arthroscopy (CPT 29870) if it is not expected to lead to treatment. Medicare Advantage plans and traditional Medicare have the same general rules, but MA plans may require prior authorization.

Question 2

Is knee arthroscopy inpatient or outpatient?

Accepted Answer

Knee arthroscopy is almost always performed as an outpatient procedure — either in a hospital outpatient department (HOPD) or ambulatory surgery center (ASC). Inpatient admission is rarely medically necessary. The ASC facility fee ($2,143) is significantly lower than the HOPD fee ($3,214), a difference of $1,071. Your 20% coinsurance share is $429 at an ASC vs $643 at an HOPD. Choosing an ASC saves approximately $214 in out-of-pocket costs.

Question 3

What CPT code does Medicare use for knee scope surgery?

Accepted Answer

The most common CPT code for Medicare knee arthroscopy is CPT 29881 (arthroscopy with meniscectomy, medial or lateral). If both menisci are addressed in the same session, CPT 29882 (medial and lateral) may be used. CPT 29877 covers chondroplasty (cartilage shaving) and is sometimes billed with meniscectomy. The specific CPT code affects what Medicare approves and pays. You can look up the Medicare-approved amount for any CPT code at the CMS Physician Fee Schedule Look-Up Tool.

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 — Knee Arthroscopy (CPT 29881)	$515	$103
Hospital Outpatient (HOPD) Facility Fee	$3,342	$668
Ambulatory Surgery Center (ASC) Facility Fee	$1,644	$329
Anesthesia (estimated)	$300–$600	20% of approved

Setting	Facility Fee	Your 20%
Ambulatory Surgery Center (ASC)	$2,143	$429
Hospital Outpatient Dept (HOPD)	$3,214	$643

Medicare Knee Arthroscopy Cost 2026 | Out-of-Pocket Estimator

2026 Medicare Cost Summary — Knee Arthroscopy (CPT 29881)

What Medicare Pays

About This Calculator

How Much Does Knee Arthroscopy Cost with Medicare?

Knee Arthroscopy Cost: ASC vs. Hospital

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