Episodes
What Procedures And Services Are Included In CJR-X?
CJR-X covers eligible hip, knee, and ankle lower-extremity joint replacements. Unlike the original CJR model, it explicitly spans qualifying inpatient and hospital outpatient procedures.
The accountable episode begins with the procedure and extends through 90 days of recovery, capturing most related Original Medicare Part A and Part B spending.
Qualifying Procedures
| Setting | Codes | Procedures |
|---|---|---|
| Inpatient | MS-DRG 469, 470, 521, 522 | Major hip and knee replacement, lower-extremity reattachment, qualifying total ankle replacement, and hip replacement associated with hip fracture. |
| Hospital outpatient | HCPCS 27447, 27130 | Total knee arthroplasty and total hip arthroplasty. |
The 90-Day Accountability Window
With limited exceptions, the episode includes related Medicare Part A and Part B items and services from the anchor procedure through 90 days after discharge or the outpatient procedure. That can include the hospital stay, physician services, physical therapy, skilled nursing, home health, follow-up visits, emergency care, complications, and readmissions.
Why 90 Days Changes the Operating Model
Hospitals need visibility well beyond discharge. Recovery pathways, rehabilitation settings, patient adherence, complications, and avoidable utilization across three months can all affect reconciliation. A 30-day follow-up workflow built for TEAM is not sufficient by itself for CJR-X.
Patient and Provider Choice
Medicare continues to pay providers and suppliers under existing payment systems, and beneficiaries retain freedom of choice among Medicare providers. The hospital's role is to coordinate the episode, share appropriate information, support informed navigation, and reduce avoidable complications and unnecessary care without restricting patient choice.
Episode Questions
Which procedures are included in CJR-X?
CJR-X includes eligible lower-extremity joint replacements: hip and knee replacements in inpatient or hospital outpatient settings and qualifying ankle replacements in the inpatient setting.
How long is a CJR-X episode?
The episode begins with the qualifying inpatient hospitalization or outpatient procedure and continues through 90 days after discharge or completion of the outpatient procedure.
Does CJR-X include outpatient joint replacements?
Yes. CJR-X includes eligible total hip and total knee arthroplasty performed in hospital outpatient departments, in addition to qualifying inpatient procedures.
Last reviewed: August 16, 2026 Primary source: CMS CJR-X Model (cms.gov)