Complete Guide
The CJR-X Model: What Hospitals Need To Know Before 2028
The Comprehensive Care for Joint Replacement Expanded (CJR-X) Model is a mandatory nationwide Medicare episode-based payment model finalized in the FY 2027 IPPS Final Rule on July 31, 2026. It begins January 1, 2028.
CJR-X is a mandatory bundled payment model that makes nearly every eligible acute-care hospital financially accountable for the cost and quality of hip, knee, and ankle replacement episodes from the qualifying procedure through 90 days of recovery.
In This Guide
Participants
Determine whether your hospital must participate, including TEAM, Maryland, IPPS/OPPS, rural, and critical-access exclusions.
Episodes
Understand qualifying hip, knee, and ankle procedures and which Medicare Part A and B services fall inside the 90-day episode.
Payments & Quality
Learn how target prices, annual reconciliation, composite quality scoring, stop-loss protection, and 29 risk adjusters work.
Preparation
Build the physician alignment, post-acute network, data, quality, and patient-navigation capabilities CJR-X requires.
FAQ
Get direct answers about the start date, mandatory participation, TEAM overlap, procedure codes, and patient choice.
Guided by the R.A.I.N. Advisory Committee
Rainfall's advisory committee includes health system, policy, and compliance leaders who help shape episode accountability standards for mandatory Medicare models like TEAM and CJR-X.
Mandatory Bundled Payments and Hospital Financial Accountability
Hospitals continue billing Medicare fee for service, but CMS later compares episode spending with a quality-adjusted target price. That reconciliation creates direct hospital financial accountability for performance across the full 90-day episode.
- • Status: Finalized in the FY 2027 IPPS Final Rule on July 31, 2026.
- • Start date: January 1, 2028.
- • Participation: Mandatory nationwide for most acute-care hospitals paid under both IPPS and OPPS.
- • Exclusions: TEAM participants, Maryland hospitals, and hospitals not paid under both IPPS and OPPS.
- • Procedures: Eligible hip, knee, and ankle lower-extremity joint replacements in inpatient and hospital outpatient settings.
- • Episode window: The qualifying procedure through 90 days after discharge or the outpatient procedure.
- • Spending: With limited exceptions, related Medicare Part A and Part B services are included.
- • Reconciliation: Annual episode spending is compared with a hospital target price and adjusted for quality.
- • Quality: Hospitals must meet a minimum composite quality score before receiving reconciliation payments.
- • Risk adjustment: 29 adjusters account for hospital and patient complexity.
- • TEAM overlap: Hospitals participating in TEAM are excluded until TEAM ends; eligible hospitals then enter CJR-X.
CJR-X vs TEAM at a Glance
| Feature | CJR-X | TEAM |
|---|---|---|
| Start | January 1, 2028 | January 1, 2026 |
| Scope | Hip, knee, and ankle replacements | Five surgical episode categories |
| Window | 90 days after discharge/procedure | 30 days after discharge |
| Geography | Nationwide, with exclusions | Selected hospitals in designated markets |
CMS comment letters on CJR-X and TEAM
- CMS TEAM comment letter (June 8, 2026)
Rainfall Health comments on FY 2027 IPPS proposed TEAM CQS changes and ASC RFI.
- CJR-X comment letter (June 8, 2026)
Rainfall Health comments on the proposed nationwide CJR-X joint-replacement model.
Last reviewed: August 16, 2026 Primary source: CMS CJR-X Model (cms.gov)