UPMC Health Plan Hip and Knee Joint Replacement Surgery Centers of Excellence
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.
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.
2027 UPMC for Life Plans that qualify for Center of Excellence – Platinum provider benefits are as follows:
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
Essential Rx (PPO):
- H5533-017-002
PPO Rx Choice (PPO):
- H5533-019-000
- H5533-020-000
Preferred Rx (HMO)*:
- H3907-064-000
* For the UPMC for Life Preferred Rx (HMO), please visit the UPMC Health Plan online searchable directory to see which facilities are in-network for members with this plan type.
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
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 866-918-1595 Monday through Friday from 8 a.m. to 5 p.m.