UPMC Health Plan Hip and Knee Joint Replacement Surgery Centers of Excellence program

Hip and knee joint replacement surgery is one of the most frequently performed orthopedic surgeries among the U.S. population. With that in mind, UPMC Health Plan has established a Center of Excellence program for total hip and knee joint replacement surgery to promote high quality outcomes for our members. 

This program helps encourage the best possible outcomes for UPMC Health Plan members who need a total hip and knee joint replacement surgery. It recognizes health systems that have consistent positive outcomes, low complication rates, and low readmission rates after a total joint replacement surgery. 

Participating providers will fall into one of the following tiers. 

Tier 1: Center of Excellence – Platinum

These designated hospitals/health systems meet quality standards, while agreeing to cost of care and efficiency targets. This may indicate a lower cost-share for members in certain UPMC for Life plans.  

The following health system locations will hold the Center of Excellence - Platinum designation:

• UPMC St Margaret
• UPMC Presbyterian Shadyside - Presbyterian
• UPMC Presbyterian Shadyside - Shadyside
• UPMC Passavant - McCandless
• UPMC Magee Womens Hospital
• UPMC East
• UPMC Altoona
• UPMC Horizon - Shenango
• UPMC Hamot Medical Center
• UPMC Northwest
• UPMC Jameson
• UPMC Washington
• UPMC Somerset

These locations will have the following description listed within the participating hospital section of the provider directory: UPMCHP Hip & Knee Surgery Platinum Center of Excellence 

Starting Jan. 1, 2026, the following UPMC for Life plans qualify for Tier 1: Center of Excellence – Platinum benefits.  

UPMC for Life members may have a lower cost share when using Platinum providers. Be sure to verify your plan on your UPMC for Life member ID card. 

HMO plans	PPO plans
HMO Premier Rx: H3907-059-001 HMO Premier Rx: H3907-059-005 HMO Rx Choice: H3907-057-001 HMO Rx Choice: H3907-057-002 HMO Rx Choice: H3907-057-003 HMO Rx Choice: H3907-057-005 HMO Rx Choice: H3907-057-006 HMO Rx Choice: H3907-057-007 HMO Rx: H3907-058-002 HMO Rx: H3907-058-003	PPO Essential Care Rx: H5533-017-002 PPO Rx Choice: H5533-015-001 PPO Rx Choice: H5533-015-002 PPO Rx Choice: H5533-015-003 PPO Rx Choice: H5533-015-006

 

To get more information about costs, benefits, or rules, see your Evidence of Coverage. You can find it on our website by visiting Medicare Shop or by logging into the UPMC Health Plan member site. You may also call the UPMC for Life Health Care Concierge team at the phone number on your member ID card to ask us to mail you hard copy plan information. 

Tier 2: Center of Excellence

Hospital/Health system meets quality standards. 
Services received from Tier 2 locations are not included in cost-share reduction program benefits. 

The following health system locations will hold the Center of Excellence designation:

• Independence Health- Westmoreland Regional Hospital 
• Independence Health- Latrobe Area Hospital 
• Independence Health- Butler Memorial 
• Heritage Valley Sewickley 
• Heritage Valley Beaver 
• Penn Highlands- Mon Valley 
• Penn Highlands- Dubois 
• PHMA - Indiana Regional 
• PHMA - Armstrong County 
• Windber Medical Center 
• St. Clair Memorial Hospital 
• Uniontown Hospital 
• AHN Jefferson 

Tier 3: Standard

This tier encompasses the rest of the network.  
Services received from Tier 3 locations are not included in cost-share reduction program benefits. 

Have questions, need help verifying your plan benefits, or need assistance selecting a provider for your upcoming surgery?  
We’re here for you. To verify this benefit is offered with your plan or for questions, please call us at 1-877-539-3080 (TTY: 711). Our hours of operation change twice a year. October 1 through March 31 you can reach us seven days a week from 8 a.m. to 8 p.m. April 1 through September 30 you can reach us Monday through Friday from 8 a.m. to 8 p.m.