CJR-X vs TEAM: Key Differences Between the Medicare Models

CMS is expanding episode-based payment across Medicare, and two models are likely to receive considerable attention from organizations managing surgical care: CJR-X and TEAM.

The models share a basic premise. Hospitals are held accountable for the cost and quality of care surrounding a surgical episode rather than focusing solely on the procedure itself. Yet the similarities can make CJR-X vs TEAM confusing.

The biggest differences come down to which hospitals participate, which procedures are included, and how long financial accountability continues after surgery. TEAM began January 1, 2026, in selected geographic areas and covers five categories of surgical procedures over a 30-day episode. CJR-X begins January 1, 2028, applies to most eligible hospitals nationwide, focuses specifically on lower extremity joint replacement, and extends the episode through 90 days after discharge or the outpatient procedure.¹ ²

Those distinctions can change how organizations approach care coordination, rehabilitation, post-acute utilization, patient follow-up, outcomes measurement, and financial planning.

CJR-X vs TEAM at a glance

Both programs are mandatory episode-based payment models developed by the CMS Innovation Center, but they are designed differently.¹ ²

TEAM applies to lower extremity joint replacement, surgical hip and femur fracture treatment, spinal fusion, coronary artery bypass graft surgery, and major bowel procedures. Its episodes run from the qualifying surgery through 30 days after the patient leaves the hospital.¹

CJR-X has a narrower procedural focus but a longer accountability period. Its episodes center on eligible hip, knee, and ankle replacements and continue for 90 days. CMS states that related Medicare Part A and Part B services during the episode can include the procedure, hospital stay, post-discharge physical therapy, and follow-up visits.²

That 60-day difference is one of the most important distinctions when comparing CJR-X vs TEAM.

1. CJR-X covers joint replacement, while TEAM covers five surgical categories

TEAM was designed as a broader surgical episode model.

Under TEAM, qualifying episodes include five procedure categories:

• Lower extremity joint replacement

• Surgical hip and femur fracture treatment

• Spinal fusion

• Coronary artery bypass graft surgery

• Major bowel procedures¹

This means participating hospitals may need care coordination and cost-management processes spanning several clinical service lines.

CJR-X is more focused. It applies to lower extremity joint replacements involving eligible hip, knee, and ankle procedures. Qualifying episodes may be triggered through inpatient MS-DRGs or outpatient HCPCS codes, meaning CJR-X is relevant to joint replacement care delivered in both settings.²

The narrower procedure scope does not necessarily mean less operational work.

Joint replacement recovery frequently extends well beyond discharge. Rehabilitation, mobility progression, pain management, follow-up care, post-acute services, emergency department visits, and readmissions can all influence spending during the CJR-X episode.

For organizations already participating in TEAM, many of the operational lessons gained from managing lower extremity joint replacement episodes may help with future CJR-X preparation. CMS has also stated that hospitals participating in TEAM will be excluded from CJR-X while TEAM remains active. After TEAM ends, eligible hospitals may be required to participate in CJR-X.²

2. The biggest difference may be 30 days vs 90 days

TEAM episodes end 30 days after the patient leaves the hospital. CJR-X episodes continue through 90 days after discharge from an inpatient hospitalization or completion of an eligible outpatient procedure.¹ ²

For joint replacement care, those additional 60 days can substantially expand the portion of recovery that falls within the hospital's episode.

Consider a patient who receives a total knee replacement.

During the first 30 days, the care pathway may involve hospital discharge, the beginning of rehabilitation, medication management, surgical follow-up, and monitoring for early complications. A TEAM joint replacement episode generally ends after that period.

Under CJR-X, the accountability window continues for another two months.

Physical therapy visits, follow-up appointments, post-acute services, complications, and related hospital utilization occurring later in recovery can still contribute to episode spending. CMS specifically identifies post-discharge physical therapy as an example of a service included in CJR-X.²

The longer timeline makes sustained patient engagement more important.

A strong discharge process remains valuable, but organizations preparing for CJR-X may also need better visibility into what happens during weeks 5, 8, or 12 of recovery. That can include monitoring adherence to rehabilitation, collecting patient-reported outcomes, identifying changes in function, and connecting patients with the appropriate level of care before a problem leads to higher-cost utilization.

CMS has stated that evidence from CJR-X and TEAM could help it compare outcomes under different episode lengths.²

3. Both models use target prices, but participation and risk structures differ

The payment mechanics behind CJR-X and TEAM share several characteristics.

Hospitals and other providers continue billing Medicare fee-for-service during the episode. CMS then compares actual episode spending with a target price. Depending on cost and quality performance, participating hospitals may receive additional Medicare payments or owe money back to CMS.¹ ²

TEAM, however, includes three participation tracks that create different levels of financial risk.

Track 1 provides no downside risk and lower reward levels during the first year. Eligible safety-net hospitals may remain in Track 1 for up to three years.

Track 2 provides lower levels of risk and reward for qualifying participants, including certain safety-net and rural hospitals, during performance years two through five.

Track 3 carries higher levels of risk and reward across the model's performance years.¹

TEAM, therefore, includes a staged path into financial accountability for participating organizations.

CJR-X has its own protections. CMS finalized a 5 percent stop-loss limit for certain organizations, including hospitals serving a high proportion of patients who are dually eligible for Medicare and Medicaid, certain geographically rural hospitals, Medicare-dependent hospitals, small rural hospitals, and Sole Community Hospitals.²

The models also share many risk-adjustment concepts. CMS states that CJR-X uses 29 risk adjusters, the same number used in TEAM. Factors include age, chronic condition burden, dual eligibility, disability as the original reason for Medicare enrollment, prior post-acute care use, procedure type, and specified Hierarchical Condition Categories.²

4. CJR-X and TEAM make post-acute coordination a financial issue

The broader message behind CJR-X and TEAM is similar: what happens after surgery increasingly matters to Medicare payment.

Hospitals cannot manage episode performance by looking only at operating room efficiency or inpatient length of stay. Performance can also depend on post-acute utilization, readmissions, emergency department visits, rehabilitation, follow-up care, and patient outcomes.

TEAM participants are accountable for included spending through day 30 and must refer patients to primary care services to support continuity beyond the surgical episode.¹

CJR-X extends direct episode accountability to 90 days for joint replacement patients, making the rehabilitation portion of recovery particularly relevant.²

For example, imagine a hospital performs 500 Medicare knee replacements during a performance year.

Data show that surgical costs are relatively consistent, but there is wide variation after discharge. Some patients progress through outpatient rehabilitation as planned. Others experience gaps in care, use higher levels of post-acute services, or return to the emergency department when symptoms worsen.

Under an episode model, that variation is no longer disconnected from hospital financial performance.

The organization may respond by creating a more standardized recovery pathway that includes preoperative education, digital home exercise programs, post-discharge monitoring, patient-reported outcome collection, and clear escalation protocols when recovery begins moving off course.

These processes can provide better visibility into the period between clinical visits and help teams identify areas where episode spending and patient outcomes vary.

What should organizations do about CJR-X and TEAM now?

The first question is straightforward: Determine which model applies to your hospital.

TEAM is active from January 1, 2026, through December 31, 2030, for participating hospitals in selected Core-Based Statistical Areas. CMS reports 716 TEAM participants as of August 2026.¹

CJR-X begins January 1, 2028, and will apply to most hospitals paid under both IPPS and OPPS nationwide. Hospitals participating in TEAM are excluded from CJR-X during TEAM participation, as are hospitals in Maryland and organizations that do not meet the applicable IPPS and OPPS payment criteria.²

From there, organizations preparing for either model can examine:

• Current episode spending by procedure

• Post-acute care utilization

• Emergency department visits and readmissions

• Rehabilitation utilization and adherence

• Variation among care pathways

• Patient-reported outcomes

• Care transitions between hospital and community providers

• Data visibility after discharge

• Processes for identifying patients whose recovery is falling behind

Organizations already working under TEAM also have an opportunity to treat the model as preparation for a longer episode structure. Joint replacement workflows developed around a 30-day TEAM episode can provide a starting point for understanding the additional requirements created by a 90-day CJR-X episode.

The difference between CJR-X vs TEAM is therefore bigger than the name of the Medicare model. TEAM applies across more types of surgery, but within a shorter episode and selected geographic areas. CJR-X focuses specifically on lower extremity joint replacement while extending accountability across a much longer portion of recovery and reaching most eligible hospitals nationwide.

For organizations preparing for Medicare's continued shift toward episode-based payment, the common priority is clear: better visibility into what happens to patients after surgery can support stronger cost management, care coordination, and outcomes across the entire episode.

References

¹ Centers for Medicare & Medicaid Services. TEAM Model. CMS Innovation Center. Updated August 4, 2026.
https://www.cms.gov/priorities/innovation/innovation-models/team-model

² Centers for Medicare & Medicaid Services. CJR-X Model. CMS Innovation Center.
https://www.cms.gov/priorities/innovation/innovation-models/cjr-x

³ Centers for Medicare & Medicaid Services. FY 2027 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule (CMS-1849-F). July 31, 2026.
https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-long-term-care-hospital-prospective-payment

⁴ Centers for Medicare & Medicaid Services. TEAM Frequently Asked Questions.
https://www.cms.gov/priorities/innovation/team-frequently-asked-questions