Cross-Border Directive for Hip and Knee Replacement: Step by Step for Irish Patients (2026)

The HSE accepts either:

• a referral letter from a GP, or from a consultant you saw as a public patient. A referral from a private consultation does not count, even if you have health insurance; or
• a letter confirming you are on a public waiting list in Ireland for the same treatment.

The referral can be to a public service in Ireland or to a public or private hospital abroad. It must include your name, address and date of birth; the name and address of the hospital and the specialty (orthopaedics); a summary of your condition and diagnosis; the reason for the referral; and the referring doctor's signature (an electronic referral does not need one). It must be dated before your outpatient consultation.

A GP referral directly to a hospital abroad means you do not have to wait for a first Irish orthopaedic appointment. At the end of September 2026, 82,991 adults were waiting for one (NTPF).

Before inpatient or day case treatment you must have an outpatient consultation, either with your treating surgeon abroad or with a consultant in Ireland who sees you as a public patient.

• Joint replacement is inpatient care, so the consultation must be in person.
• For day case procedures, such as many knee arthroscopies, it can be by phone or video.

The HSE suggests holding the consultation on a day before your admission, so you have time to decide whether you are comfortable with the surgeon and the hospital. Keep proof of it: you will need to send it with your forms.

Before you travel you can send the HSE a prior notification application form. It is optional. The HSE will then confirm whether you are eligible and give an indication of how much you may get; the exact amount is confirmed only after treatment.

With the form you send proof of your outpatient consultation and a copy of your referral letter or waiting-list letter. Section 4 of the form is completed by the healthcare professional abroad. If your surgeon changes the treatment on the day, you can claim only for the treatment you actually had.

You pay the hospital directly. The HSE needs:

Anything not in English needs a certified translation. Payments to a third party or intermediary are not repaid, which is why at our partner hospital you pay the hospital's own bank account and OrthoVoyage adds no fee to your invoice. The hospital is paid a deposit to book your date, with the balance before or on admission.

After treatment, send the HSE the healthcare costs application form (section 4 again completed by the hospital abroad), your referral or waiting-list letter, the itemised invoice and proof of payment.

The HSE repays the lower of what you paid and the Irish public price for the same care, calculated from a DRG code. For a knee replacement the Irish price is €16,196 and for a hip €15,523 (ABF 2026 price list, from 1 September 2026); see all orthopaedic amounts. Payment goes to the patient. The HSE aims to pay within 30 working days of receiving all completed documents, but says that because of demand processing currently takes longer, so plan to fund the treatment for some months.

Questions about your own case: crossborderdirective@hse.ie, or HSE Live on 1800 700 700.

OrthoVoyage is a medical travel concierge, not a hospital, and does not give medical advice. The HSE decides every claim.