The Bottom Line
Medicare is taking a nationwide approach to coordinating hip, knee and ankle replacement care. Beginning January 1, 2028, most acute-care hospitals will be financially accountable for the surgery and the first 90 days after discharge under the Comprehensive Care for Joint Replacement Expanded Model, or CJR-X. The change is aimed at better coordination and fewer avoidable complications. It does not eliminate an Original Medicare patient’s freedom to choose doctors, therapists or other providers, and it does not create a new patient fee.
What Medicare finalized
The Centers for Medicare & Medicaid Services finalized CJR-X in the fiscal year 2027 hospital payment rule published in the Federal Register on August 4. The model expands nationally on an earlier Comprehensive Care for Joint Replacement test that ran from April 2016 through December 2024.
The earlier model placed participating hospitals in selected areas under financial accountability for a joint-replacement episode. CMS says that test saved Medicare more than $100 million while maintaining measured quality of care. The new model applies nationally, including U.S. territories, with specific exemptions.
The final rule identifies January 1, 2028, as the national starting date. A separate CMS model webpage, last modified August 5, currently refers to an October 1, 2027 start. Because those public summaries conflict, this report uses the published final rule as the controlling source and treats January 1, 2028, as the operative date unless CMS issues a correction or implementation guidance.
| CJR-X element | What it means |
|---|---|
| Procedures | Hip, knee and ankle replacements in inpatient or hospital outpatient settings |
| Accountability window | The procedure, hospital care and 90 days after discharge |
| Hospital reach | Most acute-care hospitals nationwide; certain hospitals are exempt |
| Patient choice | Original Medicare beneficiaries retain freedom to choose providers and services |
Why the 90-day window matters
A joint replacement is not a single-day event. The operation is followed by pain management, mobility work, physical therapy, wound monitoring, equipment needs and decisions about home health, outpatient rehabilitation or a skilled nursing facility. When those handoffs are poorly coordinated, patients can face delayed therapy, duplicated services, medication confusion or avoidable emergency visits.
CJR-X makes the hospital accountable for Medicare spending and quality across that broader episode. That gives the hospital a financial reason to coordinate with surgeons and post-acute providers rather than treating discharge as the end of its responsibility.
This is a payment model for providers, not a guarantee that every individual recovery will be faster or less expensive. CMS describes safer procedures, more coordinated recovery and fewer avoidable complications as intended outcomes. Whether those results occur nationwide will depend on implementation, patient health, local provider capacity and the quality of each discharge plan.
What does not change for patients
CMS says Original Medicare patients will keep their freedom to choose doctors, therapists and other covered providers. A hospital can recommend a preferred rehabilitation network, but the payment model itself does not give the hospital authority to take away a beneficiary’s provider choice.
Ordinary Medicare coverage and cost-sharing rules also continue to apply. In 2026, Medicare.gov says a beneficiary admitted as an inpatient generally pays the $1,736 Part A deductible for a benefit period, then $0 per day for days 1 through 60. Part B generally pays 80% of the Medicare-approved amount for covered doctors’ services after applicable requirements. Actual costs depend on inpatient versus outpatient status, supplemental coverage, provider participation and the services used during recovery.
That distinction matters because a procedure performed in a hospital does not automatically mean the patient is an inpatient. Ask the hospital whether the surgery is scheduled as inpatient or outpatient and request an estimate based on that status. Medicare Advantage members should separately verify network, authorization and cost-sharing rules with their plan.
The model’s financial reconciliation happens between Medicare and participating hospitals. CMS will compare episode spending and quality results with program benchmarks, which can produce incentive payments or repayments for hospitals under the finalized methodology. That provider-level accounting should not be confused with a bundled bill sent to the patient. Beneficiaries will continue to receive Medicare statements and provider bills under the coverage rules that apply to their care.
Patients should also avoid assuming that every service suggested during recovery is automatically covered. Before selecting a therapy provider, skilled nursing facility, home health agency or durable medical equipment supplier, confirm that Medicare covers the service, that eligibility requirements are met and that the provider accepts the applicable coverage. A coordinated discharge plan is valuable, but it does not replace an individualized coverage check.
Five questions to ask before surgery
- Will my procedure be inpatient or outpatient, and how does that change my estimated cost?
- Who is responsible for coordinating physical therapy, medications and follow-up appointments after discharge?
- Which rehabilitation providers participate in Medicare or my Medicare Advantage network?
- What warning signs should trigger a call to the surgeon, an urgent visit or emergency care?
- Whom should my family contact if equipment, home health or therapy is delayed?
Who may be outside the model
The final rule says CJR-X will generally be mandatory for acute-care hospitals, but hospitals already participating in the Transforming Episode Accountability Model are excluded. Acute-care hospitals in Maryland are also excluded because that state operates under a separate Medicare payment framework. Other facility and payment-status details can affect participation.
Patients do not need to determine model participation before receiving medically necessary care. Still, a person planning a 2028 joint replacement may reasonably ask whether the hospital participates in CJR-X and what care-coordination services it has built around the 90-day recovery period.
What to Watch
- CMS clarification of the conflicting January 1, 2028, and October 1, 2027 dates appearing on its public pages.
- Patient notices explaining hospital participation and freedom of provider choice.
- Detailed quality measures, target-price methods and financial safeguards for hospitals.
- Whether hospitals expand pre-surgery education, home-recovery support and physical-therapy coordination before launch.
- Independent evaluations comparing complications, readmissions, patient experience and Medicare spending.
Sources and Methodology
This report prioritizes the published FY 2027 hospital final rule, then uses CMS’s press release and model page for plain-language program descriptions. Current 2026 inpatient cost-sharing information was checked against Medicare.gov on August 11, 2026. Where CMS pages conflict on timing, the conflict is stated rather than resolved by assumption.
- Federal Register: FY 2027 IPPS final rule
- CMS announcement of the nationwide CJR-X expansion
- CMS CJR-X model page
- Medicare.gov inpatient hospital coverage and 2026 costs
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Health and financial information notice: This article provides general educational information and is not individualized medical, insurance or financial advice. Confirm coverage, costs and treatment decisions with Medicare, your health plan and your care team.
