CJR-X: The Complete Guide to CMS’s Nationwide Bundled Payment Model

What Hospitals Need To Know About the Final CJR-X Model

CMS has finalized CJR-X—the Comprehensive Care for Joint Replacement Expanded Model—a mandatory nationwide bundled payment model covering hip and knee replacements performed in inpatient and hospital outpatient settings, as well as inpatient total ankle replacements. Beginning January 1, 2028, eligible acute care hospitals will be accountable for the cost and quality of care through 90 days after discharge or completion of the outpatient procedure.

This guide explains how the finalized model works, which hospitals are affected and how patient-reported outcomes will influence financial performance.

In this guide we cover:

What CJR-X Is and Why It Was Finalized: The model builds on the original CJR Model’s record of reducing Medicare episode spending while maintaining quality—and expands that approach nationwide.
Who Is Affected: Most acute care hospitals paid under both IPPS and OPPS will be required to participate. Hospitals participating in TEAM, hospitals located in Maryland and facilities not paid under both systems are excluded.
How Financial Accountability Works: Hospitals may receive reconciliation payments when episode spending falls below their regional target price and quality requirements are met—or owe repayments when spending exceeds the target. Two-sided risk begins in Performance Year 1.
How Quality Determines Payment: A Composite Quality Score across five measures determines each hospital’s quality category and effective discount factor. Hospitals scoring “Below Acceptable” cannot earn a reconciliation payment, even when episode spending is under target.
The Role of the THA/TKA PRO-PM: The inpatient THA/TKA PRO-PM (CMIT ID 1618), reported through the Hospital IQR Program, will be used to score quality across both inpatient and outpatient LEJR episodes. CMS will use data already reported through its existing quality programs; hospitals will not have a separate CJR-X quality-data submission.
Key Differences From the Original CJR Model: A side-by-side breakdown of what changed, what remained and how the expanded model differs from its predecessor.
What Hospitals Should Be Doing Now: Practical steps to assess episode economics, quality performance and PRO-PM readiness before CJR-X begins January 1, 2028.