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

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.  

This program allows qualifying systems to participate in three tier levels:

• Tier 1: Center of Excellence – Platinum*

• Hospital/Health system meets program quality standards. 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. 

• Tier 2: Center of Excellence

• Hospital/Health system meets program quality standards. 

Services received from Tier 2 locations are not included in cost-share reduction program benefits.

In 2027, the following UPMC for Life Plans offer Center of Excellence – Platinum cost-share reduction program benefits.

HMO plans	PPO plans
HMO Premier RX (HMO) H3907-059-001 H3907-061-000 HMO RX Choice (HMO) H3907-057-001 H3907-057-002 H3907-057-003 H3907-057-008 H3907-062-000 HMO RX (HMO) H3907-058-002 H3907-058-003 Preferred RX (HMO)* H3907-064-000	Essential RX (PPO) H5533-017-002 PPO RX Choice (PPO) H5533-019-000 H5533-020-000

 

*For UPMC for Life Preferred Rx (HMO) members, please visit the UPMC Health Plan online searchable directory to see which facilities are in-network for your plan.

For 2027, the following health system locations hold the Center of Excellence – Platinum designation:

Tier 1: Center of Excellence- Platinum

• 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 Valley
• UPMC Hamot
• UPMC Northwest
• UPMC Jameson
• UPMC Washington
• UPMC Somerset

For 2027, the following health system locations hold the Center of Excellence designation:

Tier 2: Center of Excellence

• Westmoreland Hospital
• Latrobe Hospital
• Butler Memorial Hospital
• Heritage Valley Health System – Heritage Valley Sewickley
• Heritage Valley Health System – Heritage Valley Beaver
• Penn Highlands Mon Valley
• Penn Highlands DuBois
• Indiana Regional Medical Center
• Armstrong County Memorial Hospital
• Chan Soon-Shiong Medical Center at Windber
• St. Clair Hospital
• WVU Medicine 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. 

To get more information about costs, benefits, or rules please review the Evidence of Coverage for your plan, which you can find on our website at upmchealthplan.com/medicare/shop. You may also call Member Services and ask us to mail you an Evidence of Coverage.

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 1-866-400-5077 (TTY: 711).

Our hours of operation change based on time of 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 July 31, you can reach us Monday through Friday from 8 a.m. to 8 p.m. August 1 through September 30, you can reach us Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m.