Major Hip and Knee Joint Replacement in Texas

Musculoskeletal DRGs include hip and knee replacement, spine fusion, fracture repair, and major joint revision. Implant cost, length of stay, and rehab intensity drive most of the price variation across hospitals — DRGs 469/470 (joint replacement) are among the most-watched price benchmarks in Medicare.

Major Hip and Knee Joint Replacement is Medicare DRG 470 in the Orthopedic category. National Medicare average for this DRG is $24,455 across 3,348 reporting hospitals. The state-level view here filters that universe down to Texas only.

Texas's average for this DRG sits close to the national Medicare mean. State-level differences are explained primarily by the regional Medicare wage index — the multiplier CMS applies to standardize DRG payments to local labor costs — alongside hospital case mix and the concentration of academic referral centers in the state's larger metros.

Within the state, the 4× spread between the lowest- and highest-reporting facility usually reflects length-of-stay differences, complication adjustments for sicker patients, teaching-status add-ons, and outlier payments for unusually long stays. Two hospitals reporting the same DRG can post meaningfully different totals without anything “wrong” happening at either site. For non-Medicare patients, the more relevant figure is the negotiated commercial rate published in each hospital's machine-readable file under the CMS Hospital Price Transparency Rule.

For a planned admission, the most useful complement to the cost view is the hospital-specific quality data on CMS Care Compare. The site publishes risk-adjusted measures of mortality, readmission, complication, infection, and patient experience for every Medicare-participating hospital. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators feed many of these CMS measures.

For complex procedures, hospital-level case volume correlates with outcomes in published research, even after risk adjustment. CMS publishes case counts on Care Compare alongside outcome measures.