CMS Proposed Rule · April 2026

CJR-X is coming.
Do you know your episode cost?

CMS just proposed the first nationwide mandatory episode-based payment model for hip, knee, and ankle replacements. 2,500+ hospitals. 90-day episodes. No opt-out. Performance year begins October 2027.

SurgeonValue was built for this. Nine AI agents that scan your panel, model your episode cost, find the billable codes hiding inside your 90-day window, and collect the PROMs CMS will demand. Enter your NPI — see what we'd catch on your real panel.

See what you're leaving on the table →Preparation checklist ↓
2,500+
Hospitals affected
Mandatory, nationwide. No opt-out.
90 days
Episode window
Procedure plus everything that happens for 90 days after discharge.
$112.7M
Prior CJR savings
What CMS extracted from the original CJR pilot before going nationwide.
Oct 2027
Mandatory start date
Performance year begins. The hospitals who waited are already late.
What changed

Every post-op decision now has a dollar sign.

Under CJR-X, CMS sets a target price for every joint replacement episode. That target covers the procedure plus everything for 90 days after discharge — physical therapy, follow-up visits, imaging, DME, readmissions.

Come in under the target? Your hospital shares in the savings. Come in over? Your hospital absorbs the difference.

Which SNF. How many PT visits. When to see the patient back. These are now financial decisions, not just clinical ones.

Side by side
CJR-X (proposed)
TEAM (active)
Scope
Joints only (hip, knee, ankle)
5 episode types
Episode window
90 days
30 days
Mandatory?
Yes — nationwide
Yes — 188 metros only
Hospitals
2,500+
741
Performance start
Oct 2027
Jan 2026 (active)
Preparation checklist

What to do now — not in 2027.

18 months from rule to performance year. The hospitals that wait are already late. The work below is what wins the first measurement period.

01

Know your episode cost

What does a total knee actually cost over 90 days? Most surgeons can't answer. The winners will know before performance year starts.

02

Audit your billing

RTM 98975–98981, CCM 99490–99491, prolonged services 99417, caregiver training 96202–96203 — every unbilled code is money left on the table that won't help you hit target.

03

Track post-acute utilization

SNF days, home health visits, ED visits, readmissions — all count against your episode. Understand your referral patterns now or pay for them in 2027.

04

Collect patient-reported outcomes

PROMIS, HOOS, KOOS at baseline and 90 days. Required under TEAM and almost certainly under CJR-X. Start collecting now or you'll have no data when CMS asks.

Built for this

SurgeonValue was designed for episode-based payment.

Six of the nine agents below were built specifically for the CJR-X / TEAM workflow. Each one with a deterministic trigger, a physician attestation checkpoint, and audit-defensible output.

01

Wonder Bill

Missed billable codes

Finds the revenue hiding inside your 90-day episode window.

02

Episode Cost Tracker

CJR-X target modeling

Models total episode cost against CMS target prices in real time.

03

Prior Auth Agent

60-second appeal letters

Eliminates auth delays that extend episodes and blow your target.

04

PROM Collector

Voice-first patient outcomes

Collects PROMIS / HOOS / KOOS at baseline and 90-day passively.

05

Documentation Agent

Audit-ready notes

Ensures every encounter supports the codes billed in the episode.

06

RTM / CCM Enrollment

Recurring revenue capture

Captures 98975–98981, 99490, 99491 within every active episode.

Timeline

CJR-X roadmap.

April 2026
Now
Proposed rule published. 60-day public comment period opens.
April 2026
Now
Prior auth reform proposed alongside: 24-hr urgent / 72-hr standard decisions, FHIR-based electronic PA.
Late 2026
FY2027 IPPS Final Rule. CJR-X finalized with edits from comment period.
Oct 1, 2027
CJR-X mandatory for ~2,500 hospitals nationwide. Performance year begins.

18 months to performance year.
See what we'd catch.

Enter your NPI. SurgeonValue scans your last 90 days of joint cases, models your episode cost against the proposed CJR-X target prices, and shows you exactly which billable codes are sitting unbilled inside your existing window.

Try SurgeonValue with your NPI →