CMS has finalized its rollout of the Comprehensive Care for Joint Replacement Expanded (CJR-X) model, as included in the fiscal year 2027 Inpatient and Long-Term Care Hospital Prospective Payment System (IPPS) Final Rule, released July 31, 2026. 
 
Starting Oct. 1, 2027, hospitals across the nation will be responsible for care quality and Medicare costs 90 days after lower extremity joint replacements such as hip, knee and ankle replacements.  
 
Following the end of a model performance year, actual total spending for the episode will be compared to the participant hospital’s target price and, depending on quality and spending performance, the hospital could receive an additional payment from Medicare or be required to repay a portion of the episode spending. 
 
CJR-X will be mandatory nationwide, except for providers participating in the Transforming Episode Accountability Model (TEAM). It is set to begin Jan. 1, 2028. 
 
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