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For nearly all acute care hospitals in the United States, a new mandatory payment model is on the horizon. The Centers for Medicare and Medicaid Services (CMS) has proposed the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, a mandatory, nationwide, episode-based payment model for lower extremity joint replacements (LEJRs) in Medicare fee-for-service (FFS). If finalized, the CJR-X Model would begin October 1, 2027 as the first expansion of an episode-based payment model and the largest episode-based payment model in Medicare’s history.1
The CJR-X Model is a proposed expansion of the original CJR Model, which ran from April 2016 through December 2024. The expansion proposal is grounded in the CJR Model’s seventh annual evaluation report, which found that CJR methodologies produced $112.7 million in net Medicare savings across performance years 6 and 7 while maintaining quality of care.2 The CJR-X Model would build on the CJR Model’s episode methodology while incorporating risk adjustment and other design improvements developed for the Transforming Episode Accountability Model (TEAM), which launched January 1, 2026.3
CMS proposed the CJR-X Model in the fiscal year 2027 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule. Unless otherwise noted, all information here describing the CJR-X Model comes from this proposed rule, which was released on April 14, 2026.4