2027 IPPS final rule: CJR-X moves ahead, TEAM updates
CMS is moving forward with it’s plans for a mandatory nationwide rollout of the Comprehensive Joint Replacement Expanded (CJR-X), according to the 2027 Inpatient Prospective Payment System (IPPS) final rule.
CMS finalized a 2.3% increase to IPPS payments for fiscal year 2027, slightly lower than the 2.4% the agency floated in the proposed rule.
CJR-X will begin January 1, 2028, three months later than proposed. Procedures that will be part of the model include:
- MS-DRG 469 - Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity with Major Complications or Comorbidities (MCC) or Total Ankle Replacement
- MS-DRG 470 - Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC
- MS-DRG 521 - Hip Replacement with Principal Diagnosis of Hip Fracture with MCC
- MS-DRG 522 - Hip Replacement with Principal Diagnosis of Hip Fracture without MCC
- HCPCS 27447 – Total Knee Arthroplasty
- HCPCS 27130 – Total Hip Arthroplasty
Episode length will be 90 days. Hospitals participating in CJR-X will be responsible for spending and quality of care during an inpatient stay or hospital outpatient procedure for one of the covered MS-DRGs.
Hospitals participating in the Transforming Episode Accountability Model (TEAM) and Maryland hospitals will be excluded from CJR-X. See the CJR-X web page for more details and an FAQ.
CMS also finalized updates to TEAM, including policies affecting episode category triggers, quality measure assessments, and target price construction.
The rule also covers numerous changes to quality reporting measures, graduate medical education payment updates, clarification of organ acquisition reimbursement policies, and other policies updates.
Most provisions of the final rule take effect on October 1, 2026, unless otherwise noted.