Frequently Asked Questions
CJR-X Questions And Answers
These answers summarize the finalized CMS CJR-X Model for hospital executives, finance leaders, orthopedic service lines, quality teams, and care-management teams.
Rainfall Health reviews this guide against the CMS Innovation Center model page and updates it when CMS publishes implementation details.
What is CJR-X?
The Comprehensive Care for Joint Replacement Expanded (CJR-X) Model is a mandatory nationwide Medicare episode-based payment model for eligible hip, knee and ankle replacements. CMS finalized it on July 31, 2026.
When does CJR-X start?
CJR-X begins January 1, 2028. CMS delayed the start from the proposed October 1, 2027 date to give hospitals additional preparation time.
Is CJR-X mandatory nationwide?
Yes. It is mandatory nationwide for most eligible acute-care hospitals paid under both IPPS and OPPS, subject to specific exclusions.
Which hospitals are excluded from CJR-X?
Exclusions include hospitals participating in TEAM, Maryland hospitals, and hospitals not paid under both IPPS and OPPS. Critical Access Hospitals and Rural Emergency Hospitals therefore do not participate.
Will hospitals participate in TEAM and CJR-X at the same time?
No. TEAM participants are excluded from CJR-X while TEAM is active. After TEAM ends on December 31, 2030, otherwise eligible hospitals enter CJR-X.
Which procedures are included?
CJR-X includes qualifying hip and knee replacements performed in inpatient and hospital outpatient settings and qualifying ankle replacements performed in the inpatient setting.
How long is the CJR-X episode?
The episode begins with the qualifying procedure and continues through 90 days after discharge or the outpatient procedure.
What Medicare spending is included?
With limited exceptions, CJR-X includes related Original Medicare Part A and Part B spending, including the procedure, hospital stay, physical therapy, follow-up visits, post-acute care, complications and readmissions.
How does reconciliation work?
Medicare continues paying providers under existing systems. After the performance year, CMS compares actual episode spending with the hospital target price and quality performance. The hospital may receive an additional payment or owe Medicare.
Which quality measures does CJR-X use?
CJR-X uses five measures covering hip and knee complication rates, seven-day visits after outpatient surgery, HCAHPS, OAS CAHPS and the THA/TKA patient-reported outcome performance measure.
How does CJR-X differ from TEAM?
CJR-X is nationwide, focuses on lower-extremity joint replacement and uses a 90-day episode. TEAM applies to selected hospitals, covers five surgical episode categories and uses a 30-day post-discharge window.
Do Medicare patients keep provider choice?
Yes. CJR-X does not remove a beneficiary’s freedom to choose Medicare providers and services. Hospitals must coordinate care without improperly restricting patient choice.
Last reviewed: August 16, 2026 Primary source: CMS CJR-X Model (cms.gov)