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# CMS proposes deep cuts to joint replacement work value, final rule due
- URL: https://members.americanhealthintel.com/2026-10-21-serviceline/
- Published: 2026-10-21T20:53:10.000Z
- Updated: 2026-10-21T20:53:10.000Z
- Description: Plus: CJR-X mandatory joint bundle starts January 1, 2028. The day's rules, money, and enforcement, sourced and tiered below.
- Author: American Health Intel

Plus: CJR-X mandatory joint bundle starts January 1, 2028\. The day's rules, money, and enforcement, sourced and tiered below.

| American Health Intel Rules · Money · Medicine · Decoded daily The Service Line Wednesday, October 21, 2026 CMS proposes deep cuts to joint replacement work value, final rule due Plus: CJR-X mandatory joint bundle starts January 1, 2028\. The day's rules, money, and enforcement, sourced and tiered below. ![](https://americanhealthintel.com/email/pulse-divider.png) Rule Confidence: High Medicare proposes to cut surgeon work value for a knee replacement by 16.6% and a hip replacement by 19.6%. The final rule is expected around November 1. Knee work RVUs would fall from 19.11 to 15.94, hip from 19.11 to 15.37\. Same-day office visits with global procedures would pay 50%. CMS projects a 7% drop in allowed charges for orthopedics. Why it matters Medicare's payment to surgeons for knee and hip replacements could fall roughly 17 to 20 percent in work value. Watch the final rule, expected around November 1, for how much of the cut survives. Sources: [CMS](https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule?ref=members.americanhealthintel.com) · [Healio](https://www.healio.com/news/orthopedics/20261015/medicare-physician-fee-schedule-2027-surgeons-who-move-cases-are-penalized-for-progress?ref=members.americanhealthintel.com) · [Aaos](https://www.aaos.org/globalassets/advocacy/rules/aaos-cy27-mpfs-proposed-rule-comment-letter.pdf?ref=members.americanhealthintel.com) Rule Confidence: High Starting January 1, 2028, most US acute care hospitals paid by Medicare must carry a 90-day bundled payment for hip, knee and ankle replacement. CJR-X covers outpatient replacements too, runs 90 days after discharge versus 30 in TEAM, and exempts TEAM hospitals, Maryland and critical access hospitals. Becker's says site-neutral pricing is planned. Why it matters Most Medicare hospitals will be paid under a mandatory 90-day bundle for joint replacements starting in 2028\. Watch how site-neutral pricing for low-acuity cases shapes where surgeries happen. Sources: [CMS](https://www.cms.gov/priorities/innovation/innovation-models/cjr-x?ref=members.americanhealthintel.com) · [Ecgmc](https://www.ecgmc.com/insights/blog/cms-issues-fy-2027-hospital-ipps-and-ltch-pps-final-rule?ref=members.americanhealthintel.com) · [Beckersasc](https://www.beckersasc.com/asc-coding-billing-and-collections/the-asc-squeeze-hiding-inside-cms-joint-replacement-mandate/?ref=members.americanhealthintel.com) Also today Providence and MultiCare settle spine surgery class actions for $155.5M [Read](https://americanhealthintel.com/editions/2026-10-21-serviceline/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition#providence-multicare-dreyer-spine-class-settlements) Spine clinic sues Surgery Partners over alleged physician poaching [Read](https://americanhealthintel.com/editions/2026-10-21-serviceline/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition#surgery-partners-south-texas-spinal-clinic-suit) CMS says global-period follow-up visits are not occurring [Read](https://americanhealthintel.com/editions/2026-10-21-serviceline/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition#pfs-global-package-postop-visits-not-occurring) Proposed cut is about $104 per Medicare total knee [Read](https://americanhealthintel.com/editions/2026-10-21-serviceline/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition#tka-work-rvu-dollar-value-per-case) 1052Records$62.6BEnforcement44Deadlines300Rules [Read this issue + the trackers](https://americanhealthintel.com/editions/2026-10-21-serviceline/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) Pick your field on the site and every story tells you what it means for you. Reply to this email and tell us what you want covered. We read everything. We show our work. We score our own calls. [Track record](https://americanhealthintel.com/ledger/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) · [Calendar](https://americanhealthintel.com/calendar/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) · [Enforcement](https://americanhealthintel.com/enforcement/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) · [X](https://x.com/amhealthintel?ref=members.americanhealthintel.com) · [LinkedIn](https://www.linkedin.com/company/american-health-intel?ref=members.americanhealthintel.com) News and analysis, not legal, medical, coding, or investment advice.You subscribed at americanhealthintel.com · [Unsubscribe](%%{unsubscribe%5Furl}%%) |
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