CJR-X (Comprehensive Care for Joint Replacement expanded) Model
Contact an Expert
Karie Untiedt
Director of Quality and Patient Safety
- Send an Email
- 573-893-3700| ext. 1369
Finalized Rule — begins January 1, 2028
What
- Nationwide bundle payment model
- Episode includes admission + 90 days post discharge care
Who
- IPPS and OPPS hospitals (excludes hospitals located in Maryland and hospitals participating in the Transforming Episode Accountability Model (TEAM))
- Original Medicare beneficiaries
- Inpatient hip, knee, ankle replacement / reattachments with MS-DRGs of 469, 470, 521 and 522
- Outpatient hip and knee procedures with Healthcare Common Procedure Coding System codes 27130 and 27447
How
- Hospitals paid under normal Medicare systems
- After performance period, CMS compares actual episode spending to target price
- Spend BELOW target and meet QUALITY standards -> reconciliation payment
- EXCEED target -> owe repayments, subject to stop-loss protections
CMS’ Reasons to Expand CJR Nationally
- Generate savings while maintaining quality
- Improve care coordination
- Reduce avoidable complications and unnecessary care
- Support recovery after surgery
- Lower Medicare spending while preserving beneficiary choice
Changes from Original CJR
- Nationwide — Mandatory for most eligible hospitals
- Includes outpatient joint replacement procedures
- Reflects shift of hip/knee replacements from inpatient to outpatient
- Broader accountability for post-acute recovery
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