References

Mandatory; five performance years 2027-01-01 to 2031-12-31; Heart failure cohort: cardiology. Low back pain cohort: anesthesiology, interventional pain management, neurosurgery, orthopedic surgery, pain management, PM&R; Adjustments -9% to +9% in the first two years, rising to -12% to +12% by the final year; Eligibility requires 20+ attributed episodes and practice in a mandatory geographic area (about one-quarter of CBSAs/metro divisions); Final PY2027 participant list posted

Performance years 2027-2031; payment years 2029-2033; Quality and cost assessed individually; improvement activities and Promoting Interoperability assessed at group level; First payment year range -9% to +9%; total positive adjustments will not exceed total negative adjustments

PY2027 performance sets the CY2029 Part B payment adjustment; Specialty is determined by the plurality of Part B claims; non-physician practitioners are not eligible; Eligibility uses data from 2 calendar years before the performance year; Data are due March 31 after the performance year; participants are exempt from MIPS for ASM years

Low back pain quality measures: Q238, Q134, Q128, Q220; an excess-utilization measure was deferred to CY2027 rulemaking; Cost: COST_LBP_1 episode-based cost measure, calculated from claims (no submission); IA-1: primary care connection and HRSN screening; IA-2: Collaborative Care Arrangement with a PCP practice; Small practice (15 or fewer NPIs) may report quality at group level; PI reported at TIN level

235 CBSAs and metropolitan divisions; NJ-related areas: Lakewood-New Brunswick NJ (29484), Trenton-Princeton (45940), Vineland (47220), Allentown-Bethlehem-Easton PA-NJ (10900), Wilmington DE-MD-NJ (48864); New York-Jersey City-White Plains (35614, Bergen/Hudson/Passaic) and Newark (35084) divisions not selected

5,556 TIN/NPI rows in total; low back pain cohort has 3,341 rows (3,319 unique NPIs) in 46 states; ORTHONJ LLC: 22 unique NPIs in the low back pain cohort, all assigned to Lakewood-New Brunswick, NJ; NJ low back pain participants: 132 (120 Lakewood-New Brunswick, 10 Trenton-Princeton, 1 Allentown, 1 Vineland)

Final participant list released and participant portal opened 2026-09-15; Data Sharing Agreement / Data Request & Attestation expected October 2026; model launch 2027-01-01

Finalized ASM at 42 CFR part 512 subpart G (90 FR 49562-49720); ASM risk levels: 9% (2029), 9% (2030), 10% (2031), 11% (2032), 12% (2033); redistribution percentage 85%; Stratified random sampling of CBSAs/metro divisions, about 40% of each of six strata; New participants identified each year from PY2028 using data from 2 years prior; once selected, a participant for the remainder of the model; Six new MVPs finalized (diagnostic radiology, interventional radiology, neuropsychology, pathology, podiatry, vascular surgery)

Confirms the adjustment applies to all Part B claims for covered professional services; Proposes replacing Q220 with Q182 Functional Outcome Assessment for the low back pain cohort; Proposes the MRI Lumbar Spine for Low Back Pain (modified for ASM) claims-based measure; Proposes a rural scoring adjustment, individual or group IA reporting, and a PRO data submission incentive; Proposes renaming the Rehabilitative Support for MSK Care MVP; three new MVPs (diabetic disease, hospitalist, hypertension); Final rule not yet published as of 2026-10-18

Trigger: outpatient E/M, therapy evaluation/service, or manipulation claim plus a confirming claim within 60 days, both with a low back pain diagnosis; Confirming codes include spine injections, spinal neurostimulators, imaging, acupuncture, remote therapeutic monitoring, dry needling; No episode opens if spine surgery occurs from 90 days before to 60 days after the trigger; Episodes 120-484 days; assigned services include spinal surgery, hospitalizations, injections, imaging, therapy, medications, DME; Exclusions include cauda equina syndrome, spinal infection, osteoporotic compression fracture, myelopathy, trauma, neoplasms

Secondary source: commentary/perspective, not an original data analysis; Argues mandatory two-sided risk may push small specialty practices toward consolidation; Recommends upside-only start, group-level reporting, and an on-ramp before interoperability penalties; Discusses the July 2025 proposed design rather than the final rule

Mandatory; five performance years 2026-01-01 to 2030-12-31; Episodes: LEJR, SHFFT, spinal fusion, CABG, major bowel procedure; from inpatient stay or outpatient procedure through 30 days after discharge; Participant list updated September 2026; FY2027 IPPS final rule updated TEAM policies

IPPS/OPPS acute care hospitals in selected CBSAs are required to participate; Three participation tracks with graduated risk; Target prices cover all non-excluded Part A and B services in the episode

721 hospitals listed (711 mandatory, 10 voluntary); CMS page cites 716 participants; 44 NJ hospitals, all in CBSA 35620 New York-Newark-Jersey City, NY-NJ; Includes Hackensack UMC (310001), Englewood (310045), Holy Name (310008), Valley (310012), Palisades (310003), Jersey City Medical Center (310074); Also Bergen New Bridge, HMH Pascack Valley, Hoboken, Bayonne, Heights University (former Christ Hospital), Secaucus University, St. Joseph's UMC, St. Mary's General; No other NJ CBSA (Philadelphia-Camden, Trenton-Princeton, Atlantic City, Vineland, Allentown) selected

TEAM episodes are initiated only by an IPPS discharge or OPPS claim at a TEAM participant hospital (§512.525(c)); Spinal fusion: HOPD HCPCS 22551, 22554, 22612, 22630, 22633; MS-DRGs 523-525 added from 2026-10-01; Discount factor: 1.5% CABG and major bowel; 2% LEJR, SHFFT, spinal fusion (§512.540(c)); Target price from Census-division regional spending, 3 baseline years weighted 17/33/50, risk adjusted; TEAM collaborators include physicians and PGPs; gainsharing conditions; alignment payments capped at 25% per non-ACO collaborator and 50% aggregate (§512.565); ASM eligibility, stratified random area selection, and payment multiplier (§§512.710, 512.750)

Established TEAM; CMS declined to make ASCs TEAM participants or episode-initiating settings, citing no prior testing, pricing, and hospital-level quality measures

Added 3 MS-DRGs that initiate TEAM spinal fusion episodes; added APC/MS-DRG update factors; full-baseline normalization; Finalized CJR-X: mandatory national LEJR model with 90-day episodes starting 2028-01-01; TEAM hospitals excluded; States the CJR Model ran from 2016-04-01 to 2024-12-31

Performance period ended 2024-12-31 (PY8); Points to the CJR-X expansion finalized in the FY2027 IPPS final rule

Model period of performance ended 2025-12-31

Runs 2026-01-01 to 2031-12-31 in AZ, NJ, OH, OK, TX, WA; New Jersey: Novitas (JL) with technology participant Genzeon Corporation; Prior authorization optional; otherwise pre-payment medical review; Medicare Advantage not affected

Prior authorization requests accepted from 2026-01-05 for dates of service on or after 2026-01-15; ESI codes 62321, 62323, 64479, 64480, 64483, 64484; PVA 22510-22515; cervical fusion 22554 only; electrical nerve stimulator 63655 only; 22551/22552 and 63650 are in the separate HOPD prior authorization program; 22585 removed December 2025; PILD (NCD 150.13) and DBS implementation delayed; Sites: office, home, HOPD, ASC; decisions in 3 days (2 expedited); UTN valid 120 days; NPI-level exemption program from July 2026

Announced a six-year model effective 2026-01-01 in selected states including New Jersey (JL); Original service list included electrical nerve stimulators, ESIs, PVA, cervical fusion, and PILD

Delays deep brain stimulation (NCD 160.24) and PILD (NCD 150.13) until a future date to be announced by notice

ESI LCDs narrowed to L39015, L39240, L36920, excluding facet joint interventions; Cervical fusion LCDs L39741, L39758, L39793; PVA LCDs L38201, L34228, L35130

A MAC denial after pre-payment review is an initial determination subject to the normal appeals process

Implements CAA 2023 section 4135 (NOPAIN): temporary additional payment for non-opioid pain treatments in HOPD and ASC, 2025-01-01 to 2027-12-31; Payment limited to an estimated average of 18% of the OPD fee schedule amount for associated services

Regulations at 42 CFR 419.43(k) and 416.174; From CY2026, qualifying products may be approved quarterly, with payment retroactive to the determination date

Bergen, Hudson, Passaic: New York-Jersey City-White Plains, NY-NJ Metro Division (35614) within CBSA 35620; Middlesex, Monmouth, Ocean, Somerset: Lakewood-New Brunswick, NJ Metro Division (29484); Essex, Hunterdon, Morris, Sussex, Union: Newark, NJ Metro Division (35084)

Cervical fusion with disc removal (22551, 22552) and implanted spinal neurostimulators (63650) in hospital outpatient departments require prior authorization since July 1, 2021; the hospital submits; decisions in 7 calendar days (2 business days expedited); valid 120 days.

New Jersey providers submit WISeR prior authorization requests either to the model participant Genzeon (HIP One portal) or to Novitas, not both.