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The Centers for Medicare & Medicaid Services (CMS) recently established CJR-X, a national episode- based payment model for lower extremity joint replacement (LEJR) procedures in the FY 2027 Medicare Inpatient Prospective Payment System (IPPS) Final Rule. This bundled payment model assesses cost and quality for 90-day episode for inpatient and outpatient hip, knee, and ankle replacements.
Beginning January 1, 2028, most acute care hospitals nationwide will be required to participate in CJR-X. CMS delayed the start by three months to provide hospitals with additional pre-implementation time.
CMS estimates that CJR-X will generate approximately $725 million in Medicare savings over its first five performance years. Because the model has no specific end date, CMS expects savings and care improvements to continue beyond the initial performance period.
The implications are substantial. For the first time, orthopedic bundled payments will operate at a near-universal national scale, providing a more complete picture of episode-based payment performance across diverse providers, markets, and patient populations.