What Medicare actually pays for after knee replacement

Reviewed by Erin Rose — healthcare price-transparency analyst. Last checked July 27, 2026. Part of the full knee-replacement recovery checklist. No affiliate links on this page — every link below goes to a primary source or another page on this site.

Which recovery items does Medicare actually cover?

All eight rows below trace to the same CMS data as the fact above. "Your share" is 20% of the fee — the coinsurance math is explained further down.

Policy citations, left to right by first appearance: Walkers (A52503), Canes and Crutches (A52459), Commodes (A52461), Seat Lift Mechanisms (A52518), Hospital Beds And Accessories (A52508). Full DME MAC policy article links are in Sources below. E0260 and E0305 price under Medicare's rental (RR) modifier only — there's no purchase option for those two; see rent vs. buy for the 13-month capped-rental mechanics.

What does Medicare not cover for bathroom safety equipment?

Nine HCPCS codes cover shower chairs, tub rails, a toilet rail, a raised toilet seat, a tub stool, and transfer benches — and every one shows zero national Medicare claims in 2024, with no purchase price in the fee schedule. That's not a gap CMS hasn't gotten to. Bath-safety equipment is excluded from the DME benefit category by statute (Social Security Act §1861(s)(6): not "primarily medical in nature").

Eight of these nine codes have no DME MAC policy article at all — the exclusion happens before any policy would apply. The raised toilet seat (E0244) is the one exception: it's specifically named noncovered in the Commodes DME MAC Policy Article (A52461), because a commode chair pushed over the toilet as a raised-seat substitute has to be billed with the same noncovered status. See the bathroom equipment spoke for the shower-chair-vs-bench and raised-seat-vs-frame buying decisions this table doesn't cover.

Do I need a prescription to get any of this paid?

Yes, and the order matters. Federal rule 84 Fed. Reg Vol 217 ("Final Rule 1713") requires two things before a supplier delivers a DME item: a face-to-face visit with your doctor, and a Written Order Prior to Delivery (WOPD) — a signed order on file before the item goes out the door, not a receipt collected afterward.

Does it matter where I buy it?

Yes — it's the difference between a claim Medicare pays and a claim that doesn't exist. Medicare only pays a supplier holding a DMEPOS supplier number issued by CMS (42 CFR § 424.57(b)(2)). Buy the identical walker, commode, or bed rail from a pharmacy shelf or Amazon instead, and there's no Medicare claim to submit at all — the seller was never set up to bill Medicare. You need both a WOPD and an enrolled supplier for Medicare to pay anything.

How much do I actually pay out of pocket?

Two numbers stack: the annual Part B deductible, then 20% coinsurance on everything after that.

• The Part B deductible comes first. You pay 100% of your Part B costs — DME included — until you hit the annual deductible. For 2026, that's $283.
• Then 20% coinsurance applies. Medicare pays 80% of whichever is lower — the supplier's actual charge or the Medicare fee-schedule amount — and you owe the remaining 20% (42 CFR § 414.210(a)). That's the "your 20% share" column in the covered-items table above.

Both numbers assume a Medicare-enrolled supplier who accepts assignment. A supplier who doesn't can charge more than the fee-schedule amount for the same item.

Can Medicare replace something I already own?

Not on demand. Federal regulation sets a minimum "reasonable useful lifetime" (RUL) of 5 years for DME, counted from the delivery date, not the manufacture date (42 CFR § 414.210(f)(1)). Within that window, Medicare only pays for a replacement if the item is lost, stolen, or irreparably damaged — ordinary wear doesn't qualify. After 5 years, a replacement is covered again if still medically necessary, on the same terms as the original.