CMS has taken the unusual step of introducing a new mandatory, shared-risk payment model that will include five surgical procedures performed in hundreds of hospitals, beginning Jan. 1, 2026. The rule covers 188 geographic regions, or nearly one-quarter of all Core-Based Statistical Areas (CBSAs) nationwide.
For such a large-scale experiment, the list of participating geographies is surprisingly hard to find, but we waded through nearly 3,000 pages of regulatory language to create a convenient, state-by-state directory. If your IPPS hospital operates in one of the areas listed below, you should begin thinking about the strategic and financial implications of the TEAM model. (And if your market crosses state lines, be sure to check for your CBSA in neighboring states.)
Following the list, we provide a more in-depth analysis of the TEAM model, including covered services, selection criteria, and financial penalties.
Alabama
- Alexander City
- Huntsville
- LaGrange (AL/GA)
Arizona
- Tucson
Arkansas
- Batesville
- Camden
- Harrison
- Hot Springs
- Memphis (AR/MS/TN)
- Searcy
California
- Bakersfield-Delano
- Crescent City
- Eureka-Arcata
- Hanford-Corcoran
- Riverside-San Bernardino-Ontario
- San Diego-Chula Vista-Carlsbad
- San Francisco-Oakland-Fremont
- San Jose-Sunnyvale-Santa Clara
- San Luis Obispo-Paso Robles
- Santa Rosa-Petaluma
Colorado
- Alamosa
- Breckenridge
- Denver-Aurora-Centennial
- Fort Collins-Loveland
- Fort Morgan
- Steamboat Springs
Connecticut
- New Haven
District of Columbia
- Washington-Arlington-Alexandria (DC/MD/VA/WV)
Florida
- Arcadia
- Crestview-Fort Walton Beach-Destin
- Deltona-Daytona Beach-Ormond Beach
- Jacksonville
- Key West-Key Largo
- Lake City
- Lakeland-Winter Haven
- Panama City-Panama City Beach
- Punta Gorda
Georgia
- Albany
- Dalton
- Douglas
- Jesup
- Rome
- Savannah
- Thomaston
- Toccoa
Idaho
- Boise City
- Twin Falls
Illinois
- Burlington (IL/IA)
- Champaign-Urbana
- Galesburg
- Kankakee
- Paducah (IL/KY)
- Peoria
- Pontiac
- Springfield
Indiana
- Auburn
- Columbus
- Madison
- Michigan City-La Porte
- Richmond
Iowa
- Cedar Rapids
- Dubuque
- Ottumwa
Kansas
- Arkansas City-Winfield
- Great Bend
- Hays
- Hutchinson
- Lawrence
Kentucky
- Bowling Green
- Corbin
- Glasgow
- Lexington-Fayette
- Middlesborough
Louisiana
- Alexandria
- Baton Rouge
- Bogalusa
- Hammond
- Lafayette
- Monroe
- Natchitoches
- Ruston
Maine
- Augusta-Waterville
- Lewiston-Auburn
Massachusetts
- Barnstable Town
- Boston-Cambridge-Newton (MA/NH)
- Providence-Warwick (MA/RI)
Michigan
- Adrian
Minnesota
- Bemidji
- Duluth (MN/WI)
- Faribault-Northfield
- Minneapolis-St. Paul-Bloomington (MN/WI)
- St. Cloud
- Worthington
Mississippi
- Corinth
- Grenada
- Laurel
- McComb
- Tupelo
Missouri
- Columbia
- Jefferson City
- Maryville
- Moberly
- Poplar Bluff
- Sedalia
Nebraska
- Scottsbluff
Nevada
- Elko
New Hampshire
- Keene
- Laconia
- Lebanon-Claremont (NH/VT)
New Jersey
- New York-Newark-Jersey City (NY/NJ)
New Mexico
- Albuquerque
- Clovis
- Farmington
- Las Vegas
- Santa Fe
New York
- Batavia
- Buffalo-Cheektowaga
- Cortland
- Massena-Ogdensburg
- Oneonta
North Carolina
- Anderson Creek
- Forest City
- Goldsboro
- Greensboro-High Point
- Kinston
- Marion
- New Bern
- Raleigh-Cary
- Sanford
- Waynesville
Ohio
- Celina
- Coshocton
- Defiance
- Findlay
- Norwalk
- Springfield
- Tiffin
- Weirton-Steubenville (OH/WV)
Oklahoma
- Altus
- Durant
- Elk City
- Muskogee
- Tulsa
- Woodward
Oregon
- Bend
- Klamath Falls
- Portland-Vancouver-Hillsboro (OR/WA)
Pennsylvania
- Bradford
- DuBois
- Erie
- Harrisburg-Carlisle
- Hermitage
- Indiana
- Lewistown
- Meadville
- Oil City
- Pottsville
- Reading
- Sunbury
- Warren
Puerto Rico
- Aguadilla
South Carolina
- Florence
- Greenville-Anderson-Greer
- Orangeburg
South Dakota
- Spearfish
Tennessee
- Kingsport-Bristol (TN/VA)
- Nashville-Davidson-Murfreesboro-Franklin
- Union City
Texas
- Amarillo
- Athens
- Fredericksburg
- Huntsville
- Midland
- Mineral Wells
- Mount Pleasant
- Paris
- Wichita Falls
Utah
- Price
- St. George
- Vernal
Vermont
- Brattleboro
Washington
- Kennewick-Richland
West Virginia
- Morgantown
- Parkersburg-Vienna
Wisconsin
- Baraboo
- Green Bay
- Kenosha
- Manitowoc
(Want to know exactly how these CBSAs were selected? In an email exchange, CMS was kind enough to provide us with a detailed methodology. It’s extremely technical – and not particularly actionable – but we’re happy to send it along if you ask.)
Digging into TEAM
In its Fiscal Year 2025 Inpatient Prospective Payment System Final Rule, the Centers for Medicare and Medicaid Services (CMS) has created a new accountability model for hospitals regarding episodic care for some of the most frequently performed surgical procedures for Medicare beneficiaries.
The Transforming Episode Accountability Model (TEAM) will reimburse participating hospitals for the 30-day episode of care versus the traditional fee-for-service model currently in use. CMS hopes that the episodic payment, similar to bundling, will reduce fragmented and duplicative spending for equipment, supplies, and services needed to provide patient care for the initial encounter and the recovery period 30 days post-procedure. The five procedures selected are:
- Coronary Artery Bypass Graft
- Lower Extremity Joint Replacement
- Major Bowel Procedure
- Surgical Hip/Femur Fracture Treatment
- Spinal Fusion
Only beneficiaries of Traditional Medicare Parts A & B are included in the model. Medicare Advantage and End-Stage Renal Disease Medicare beneficiaries are excluded.
CMS will set target prices for each of the five procedures using historical data and adjusting for regional and complexity variation. (Full pricing details are expected in late November.)
Hospitals will continue to bill for these services as usual, and then CMS will compare the actual spending to the target price. If actual spending is less than the target price and the quality measures for the program are met, then the hospital will receive the difference as an additional payment – what CMS labels a “reconciliation” payment. If actual spending exceeds the target price, the hospital will pay the difference to CMS as a repayment penalty.
Acute care hospitals in the selected CSBAs are required to participate, with the exception of Critical Access Hospitals.
CMS tells Ascendient in an email that it is currently working on a comprehensive list of hospitals that will be required to participate in TEAM, but the regulatory language indicates that participation is determined largely at the facility level, not the system level. If a hospital bills Medicare “with a CCN primary address located in one of the mandatory CBSAs,” then it will be subject to the TEAM model.
In South Carolina, for instance, Prisma Health is based in Greenville, a selected CBSA, so all of its hospitals in that region will be part of the TEAM experiment. But Prisma also has a half-dozen other hospitals in areas that were not selected for TEAM; because those facilities have unique certification numbers with CMS, they will not be required – or even eligible – to participate.
The model will begin on January 1, 2026, and end December 31, 2030. Medicare projects a five-year savings of $481 million from the TEAM model.
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