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 all our members.

The UPMC Health Plan Hip and Knee Joint Replacement Surgery Center of Excellence program recognizes health systems that demonstrate high-quality outcomes, low complication rates, and low readmission rates for Health Plan members in need of a total joint replacement surgery.

Special Credentialing of Providers and Facilities in Performing Comprehensive Joint Replacement Surgeries at Designated UPMC Health Plan Joint Replacement Surgery Centers of Excellence - CR.044

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

Tier 1: Center of Excellence – Platinum*
- Hospital/Health system meets program quality standards, while agreeing to cost of care and efficiency targets.
Tier 2: Center of Excellence
- Hospital/Health system meets program quality standards.
Standard
- This tier encompasses the rest of the network—no opt-in required. The health system meets normal UPMC Health Plan network contracted quality standards.

2026 UPMC for Life Plans that qualify for Center of Excellence – Platinum provider benefits are as follows:

HMO:

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
HMO Premier Rx: H3907-059-001
HMO Premier Rx: H3907-059-005

PPO:

PPO Rx Choice: H5533-015-001
PPO Rx Choice: H5533-015-002
PPO Rx Choice: H5533-015-003
PPO Rx Choice: H5533-015-006
PPO Essential Care Rx: H5533-017-002

For 2026, 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
UPMC Hamot Medical Center
UPMC Northwest
UPMC Jameson
UPMC Washington
UPMC Somerset

For 2026, the following health system locations hold the Center of Excellence designation:

Tier 2: Center of Excellence

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

Are you a health system interested in participating? Contracted UPMC Health Plan network facilities will receive an invitation to participate each year prior to Annual Enrollment based on their quality performance. Maintaining participation in sequential years depends on continual improvement upon quality measures and/or meeting the program's quality benchmarks.

For questions about the program, call Provider Services at 1-866-918-1595 Monday through Friday from 8 a.m. to 5 p.m.

Manuals

Manuals

Forms

Forms

Other Information

Other Information

Manuals

Manuals

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

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