CMS Finalizes Nationwide Expansion of Joint Replacement Bundled Payment Model

The Centers for Medicare and Medicaid Services (CMS) has finalized its first nationwide mandatory expanded bundled payment model, the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, in the FY 2027 Inpatient Prospective Payment System (IPPS) Final Rule released on July 31. The model builds on the original Comprehensive Care for Joint Replacement (CJR) Model, which CMS reports saved Medicare more than $100 million while maintaining quality of care for beneficiaries. 

CJR-X is a separate model from the Transforming Episode Accountability Model (TEAM), currently underway. While TEAM includes five clinical episodes, CJR-X focuses exclusively on lower extremity joint replacement procedures. Importantly, hospitals participating in TEAM are exempt from CJR-X.   

The first performance year (PY) for CJR-X will begin January 1, 2028. 

CJR-X expands the original CJR model nationwide and applies to all Medicare fee-for-service beneficiaries undergoing lower extremity joint replacements – including total hip, total knee, and total ankle procedures, including hip replacement performed following a hip fracture – performed in both inpatient and outpatient hospital settings.  

Similar to CJR and TEAM: 

Participating hospitals will be financially accountable for the cost and quality of care across a 90-day episode, beginning with the inpatient hospital admission or outpatient procedure and continuing for 90 days post discharge. The episode includes related Medicare Parts A and B services, including SNF and other post-acute care services, with limited exceptions. Like CJR, CJR-X includes the 3-day SNF waiver, allowing eligible beneficiaries to be admitted to a SNF without a prior three-day hospital stay.  

Providers will continue to bill Medicare under the traditional fee-for-service payment system. CMS will continue to pay providers as usual throughout the performance year, and hospitals' financial performance under the model will be reconciled separately based on the total cost and quality of care delivered during the episode. Although hospitals bear the financial risk, SNFs will continue to play a key role as collaborators and will have opportunities to partner with hospitals to improve quality and episode spending. 

CJR-X episodes are triggered by the following Medicare inpatient MS-DRGs and outpatient HCPCS codes: 

Please contact AHCA’s Population Health Policy Analyst Rohini Achal or Nisha Hammel, Vice President, Reimbursement Policy & Population Health with any questions. The model FAQs​ are also available.