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CostHelper > Health & Personal Care  > Orthopedics and Injuries > Shoulder Replacement

Shoulder Replacement Cost


How Much Does Shoulder Replacement Cost?

 
average costWith Health Insurance: Copay + 10%-50% Coinsurancehigh costWithout Health Insurance: $7,000-$21,000+
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Shoulder replacement surgery is used to treat chronic shoulder pain and stiffness caused by degenerative joint disease, arthritis and other conditions. During the procedure, a metal ball and polyethylene cup is used to replace the head of the upper arm bone and its socket. According to the American Academy of Orthopaedic Surgeons[1] , shoulder replacement may be an option if non-operative treatments such as arthritis medications and physical therapy don't help.

Typical costs:

  • Shoulder replacement surgery typically costs $7,000-$21,000 or more, depending on the type of implants used and the hospital in which the procedure is performed. According to a 2007 study[2] by researchers from Johns Hopkins University, a shoulder replacement's total costs, on average, are $10,351. A more recent report [3] by Zimmer, a manufacturer of orthopedic prosthetics including those used in shoulder replacements, notes that in 2011 Medicare typically paid between $10,919 and $13,413 for total, partial and reverse shoulder replacements. In Vermont community hospitals, costs for this class of surgery ranged from about $7,000 to more than $21,000.
  • Shoulder replacement surgery typically is covered by health insurance. For insured patients, out-of-pocket costs typically consist of a specialist copay, possibly a hospital copay of $100 or more, and coinsurance of 10%-50% for the procedure, which could reach the yearly out-of-pocket maximum. According to the Kaiser Family Foundation[4] , the average hospital copay is $132 for outpatient surgery and for $232 inpatient surgery. The average coinsurance rate is 17%-18%.
Related articles: Physical Therapy, EKG, Health Insurance

What should be included:
  • According to the Cleveland Clinic[5] , patients who are interested in shoulder replacement would have an initial appointment with an orthopedic surgeon. The visit may include a series of x-rays, a physical examination and a thorough review of the patient's medical history.
  • Shoulder replacement surgery[6] is an inpatient procedure. It is typically scheduled in advance, lasts about two hours, and brings an average hospital stay of one to three days. A series of pre-operative tests, including blood tests, an electrocardiogram and a physical exam will be scheduled a few weeks before surgery.
  • Depending on the damage to the cartilage, the surgeon may decide to replace only the ball of the joint. Patients who have severe arthritis, completely torn rotator cuffs, or had a previous shoulder replacement that failed, may also be advised to get a reverse total shoulder replacement[7] in which a metal ball is attached to the shoulder bone and a plastic socket to the upper arm bone.
Additional costs:
  • Physical therapy following surgery can help to improve the shoulder's range of motion. For insured patients out-of-pocket costs typically consist of a copay of $10 -$75 per session or coinsurance of 10%-50% or more. For uninsured patients it typically costs$50 -$350 or more per session.
Discounts:
  • Many hospitals offer discounts of 30% of more to uninsured/cash-paying patients. At St. Joseph Hospital[8] in Orange, CA, for example, patients without health insurance may qualify for a 45% discount off billed charges. They'll also be offered an additional 10% discount if payment is made within 10 days of receiving a bill.
Shopping for shoulder replacement:
  • The American Academy of Orthopaedic Surgeons features an orthopedic surgeon finder[9] .
Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
 
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What People Are Paying - Recent Comments
replacement criteria for insurance coverage
Amount: $0.00
Posted by: Doris Leggett in Batesville, AR.Posted: June 8th, 2016 03:06PM
my daughter has been told she must have had 3 arthroscopys before receiving a shoulder replacement. Is this correct She is 46 and this would be the 5th surgery on her rt shoulder.
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Shoulder Rep,acement
Amount: $0.00
Posted by: Mamamia in NY, NY.Posted: April 22nd, 2016 09:04AM
Insurance Carrier: Empire BlueProvider:
Total cost (2/16) was $67K hospital (1 night) and $26K Doctor. Basically painless (nerve block). PT charges not included
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shoulder replacement
Amount: $0.00
Posted by: Carolyn R Nelson in Mercer, PA.Posted: July 21st, 2015 12:07PM
Insurance Carrier: CompProvider: Comp.
I have had many experiences with the comp people concerning my left shoulder. I would like to know the quick ans. if shoulder replacement is an offer. Cost of lowest amt and the highest amt.
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shoulder replacement
Amount: $100,000.00
Posted by: robert foley in Amarillo, TX.Posted: May 24th, 2015 03:05AM
Insurance Carrier: N.O.V.Provider: Cigna
My shoulder replacement was extremely expensive. Up to 150,000. With pt. But the ins. Co. Fought the cost every time a bill came out. So the bottom line is how much did the ins. Co. Pay the total cost???
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External Resources:
  1.  orthoinfo.aaos.org/topic.cfm?topic=A00094
  2.  www.ncbi.nlm.nih.gov/pubmed/16980898
  3.  www.zimmer.com/web/enUS/pdf/Shoulder_Coding_Guide_7-21-11.pdf
  4.  kff.org/health-costs/report/employer-health-benefits-2012-annual-survey/
  5.  my.clevelandclinic.org/services/shoulder_replacement/hic_total_shoulder_joint_repl...
  6.  my.clevelandclinic.org/services/shoulder_replacement/hic_total_shoulder_joint_repl...
  7.  orthoinfo.aaos.org/topic.cfm?topic=A00504
  8.  www.sjo.org/For-Patients/Your-Hospital-Bill/Self-Pay-Discount-Program.aspx
  9.  www7.aaos.org/member/directory/directory.aspx
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