CMS announces participants in CJR-X model

CMS has named the 2,217 acute care hospitals that are required to participate in its upcoming Comprehensive Care for Joint Replacement Expanded (CJR-X) model.

Finalized in the 2027 Inpatient Prospective Payment System (IPPS) final rule, the CJR-X model will hold participating hospitals accountable for all spending and care associated with a lower extremity joint replacement (LEJR) episode, starting with the procedure and continuing through 90 days post-discharge. The model is designed as an expansion of CMS’ original Comprehensive Joint Replacement model, which launched in 2016 and produced significant Medicare savings over its eight performance years.

Although CMS initially proposed launching CJR-X on October 1, 2027, it ultimately delayed the start date to January 1, 2028, in response to industry feedback. CJR-X is the first mandatory, nationwide test of an episode-based payment model.

CJR-X episodes will include the following procedures:

• 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

Notably absent from the participant list are hospitals partaking in the Transforming Episode Accountability Model and Maryland facilities, both of which were excluded from CJR-X. There are also no Rhode Island organizations among the 2,217 participating hospitals. However, CMS noted that it plans to regularly update the list to account for hospital openings, mergers, and closures.

CMS asked participating hospitals to identify two individuals who will serve as primary points of contact for CJR-X communications and submit their information. Revenue integrity staff at participating hospitals should read the CJR-X provisions in the 2027 IPPS final rule, review current billing processes for LEJR procedures, and coordinate with other teams to prepare for the model’s January 2028 launch.