UnitedHealth Premium Physician Designation Program Procedure Episode Groups (PEG ) Description and Specialty
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1 UnitedHealth Premium Physician Designation Program Procedure Episode Groups (PEG ) Description and Specialty Coronary Artery Catheterization (Diagnostic) Cardiology Coronary Artery Catheterization (Therapeutic) Cardiology Coronary Artery Catheterization with Non Drug Stent with Acute Myocardial Infarction Coronary Artery Catheterization with Drug Stent with Acute Myocardial Infarction Invasive Therapeutic Electrophysiology (Ablation) Cardiology Cardiology Cardiology Implantable Device Defibrillator Cardiology Implantable Device Pacemaker Cardiology Appendectomy General Surgery Cholecystectomy General Surgery Diagnostic Colonoscopy General Surgery Esophagoplasty/Fundoplasty General Surgery Gastrointestinal Restrictive Procedure General Surgery Lower Gastrointestinal Removal General Surgery Lower Gastrointestinal Endoscopy with Treatment General Surgery Inguinal Hernia Repair General Surgery Incisional or Ventral Hernia Repair General Surgery Umbilical Hernia Repair General Surgery Upper Gastrointestinal Removal General Surgery Upper Gastrointestinal Endoscopy with Treatment General Surgery
2 70018 Achilles Tendon Repair Neurosurgery - Spine, Orthopaedics Ankle Ligament Repair Neurosurgery - Spine, Orthopaedics Arthroscopy of Ankle with Major Repair Neurosurgery - Spine, Orthopaedics Bunionectomy Neurosurgery - Spine, Orthopaedics Carpal Tunnel Release; Open Neurosurgery - Spine, Orthopaedics Carpel Tunnel Release (Arthroscopic) Neurosurgery - Spine, Orthopaedics Cervical Spine Fusion Neurosurgery - Spine, Orthopaedics Cervical Spine Fusion with Hardware Insertion Neurosurgery - Spine, Orthopaedics Cervical Spine Laminectomy Neurosurgery - Spine, Orthopaedics Vertebral Corpectomy Neurosurgery - Spine, Orthopaedics Repair Hammer Toe Neurosurgery - Spine, Orthopaedics Hip Replacement Neurosurgery - Spine, Orthopaedics Hip Replacement Revision Neurosurgery - Spine, Orthopaedics Therapeutic Arthroscopy of the Hip Neurosurgery - Spine, Orthopaedics Knee Replacement Surgery Neurosurgery - Spine, Orthopaedics Knee Replacement Surgery Revision Neurosurgery - Spine, Orthopaedics Knee Arthroscopy with Cruciate Ligament Repair Neurosurgery - Spine, Orthopaedics Knee Arthroscopy with Meniscectomy Neurosurgery - Spine, Orthopaedics Other Knee Arthroscopy with Treatment Neurosurgery - Spine, Orthopaedics Fusion (Lumbar Back) Neurosurgery - Spine, Orthopaedics Fusion (Lumbar Back) with Hardware Insertion Neurosurgery - Spine, Orthopaedics Decompression (Herniated Disc/Lumbar Back) Neurosurgery - Spine, Orthopaedics Lumbar Spine Revision Neurosurgery - Spine, Orthopaedics Arthrodesis (Midfoot) Neurosurgery - Spine, Orthopaedics Rotator Cuff Repair Neurosurgery - Spine, Orthopaedics Arthroscopic Decompression (Shoulder) Neurosurgery - Spine, Orthopaedics Arthroscopic Removal of Foreign Body/Debridement (Shoulder) Neurosurgery - Spine, Orthopaedics Shoulder Arthroscopy with Claviculectomy, Tenodesis or Capsulorrha Neurosurgery - Spine, Orthopaedics Shoulder Arthroscopy with Synovectomy or Lysis Adhesions Neurosurgery - Spine, Orthopaedics Arthroscopic Repair - Slap Shoulder Neurosurgery - Spine, Orthopaedics Arthroscopic Repair - Rotator Cuff Neurosurgery - Spine, Orthopaedics Colporrhaphy Obstetrics/Gynecology Cautery of Cervix Obstetrics/Gynecology 2
3 90416 Conization of Cervix Obstetrics/Gynecology Endometrial Ablation Obstetrics/Gynecology Excision of Ovary/Ovarian Duct Obstetrics/Gynecology Excision of Fibroid Tumor(S) of Uterus Obstetrics/Gynecology Hysteroscopy with Treatment Obstetrics/Gynecology Incision and Drainage of Bartholin's Gland Abscess Obstetrics/Gynecology Lysis and Adhesion of Ovary/Ovarian Duct Obstetrics/Gynecology Ovary/Ovarian Duct Removal Obstetrics/Gynecology Supracervical Hysterectomy Obstetrics/Gynecology Stress Incontinence Repair Obstetrics/Gynecology, Urology Total Abdominal Hysterectomy Obstetrics/Gynecology Vaginal Hysterectomy Obstetrics/Gynecology Aqueous Shunt To Extraocular Reservoir Ophthalmology Cataract Removal Ophthalmology Closure of the Lacrimal Punctum Ophthalmology Correction of Lid Ophthalmology Dacryocystorhinostomy Ophthalmology Destruction of Retina Ophthalmology Dilation of Lacrimal Punctum Ophthalmology Discission of Secondary Membranous Cataract Ophthalmology Exchange of Intraocular Lens Ophthalmology Excision and Repair of Eyelid Ophthalmology Excision of Lesion - Cornea Ophthalmology Excision or Transposition of Pterygium Ophthalmology Fistulization of Sclera for Glaucoma Ophthalmology Iridotomy/Iridectomy Ophthalmology Insertion of Intraocular Lens Prosthesis Ophthalmology Iridoplasty Ophthalmology Intravitreal Injection of a Pharmacologic Agent Ophthalmology Keratoplasty Ophthalmology Optic Nerve Decompression Ophthalmology Orbitotomy Ophthalmology 3
4 12507 Prophylaxis of Retinal Detachment Ophthalmology Probing of Nasolacrimal Duct Ophthalmology Removal of Foreign Body - External Eye Ophthalmology Operative Wound of Anterior Segment - Revision or Repair Ophthalmology Repair of Blepharoptosis Ophthalmology Repair of Ectropion Ophthalmology Repair of Brow Ptosis Ophthalmology Repair of Retinal Detachment Ophthalmology Strabismus Revision Ophthalmology Severing of Vitreous Strands Ophthalmology Trabeculoplasty By Laser Surgery Ophthalmology Vitrectomy Ophthalmology Insertion of Inflatable Urethral/Bladder Neck Sphincter Urology Cystourethroscopy with Treatment Urology Cystoplasty or Cystourethroplasty Urology Cystectomy Urology Cystorrhaphy Urology Transurethral Destruction of Prostate Tissue Urology Excision of Extraparenchymal Lesion of Testis Urology Exploration for Undescended Testis Urology Laser Coagulation Urology Litholapaxy Urology Lithotripsy Urology Laparoscopic Nephrectomy Urology Nephrectomy Urology Nephrolithotomy Urology Laparoscopic Orchiectomy Urology Orchiectomy - Partial Urology Orchiectomy - Radical Urology Orchiopexy Urology Prostatectomy - Radical Urology Prostatectomy - Subtotal Urology Exposure of Prostate/Insertion of Radioactive Substance Urology 4
5 52714 Laparoscopic Prostatectomy Urology Prostatotomy Urology Pyeloplasty Urology Renal Endoscopy with Treatment Urology Testicular Injury Suture or Repair Urology Renal Transplant Urology Reduction of Torsion of Testis - Surgical Urology Sling Operation for Correction of Male Urinary Incontinence Urology Transurethral Resection of Bladder Neck Urology Ureter-Bladder Anastomosis Urology Ureter-Intestine Anastomosis Urology Ureterolysis Urology Vesicourethropexy Urology 5
6 Important Program Information The information from the Premium physician designation program is not an endorsement of a particular physician or health care professional's suitability for the health care needs of any particular member. UnitedHealthcare does not practice medicine nor provide health care services. Physicians are solely responsible for medical judgments and treatments supplied. The quality and/or cost efficiency designation of a physician does not guarantee the quality of health care services members will receive from a doctor and does not guarantee the outcome of any health care services members will receive. Likewise, the fact that a physician may not be designated by this program does not mean that the physician does not provide quality health care services. All physicians in the UnitedHealthcare Network have met certain minimum credentialing requirements. Regardless of whether a physician has received a designation, members have access to all physicians in the UnitedHealthcare Network, as further described under the member's benefit plan. The assessment result Not Enough Data to Assess is not an indicator of the total number of patients treated by the physician or the number of procedures performed by the physician. Rather, it reflects the statistical requirements of the Premium designation program, which includes only health plan claims associated with specific program measures and relevant to the physician s designated specialty. In some cases, there may not be enough data to complete the analytic process from a statistical standpoint. UnitedHealthcare informs members that designations are intended only as a guide when choosing a physician and should not be the sole factor in selecting a physician. As with all programs that evaluate performance based on analysis of a sample, there is a risk of error. There is a risk of error in the claims data used in the evaluation, in the calculations used in the evaluation, and in the way the program determined that an individual physician was responsible for the treatment of the patient's condition. Physicians have the opportunity to review and reconsider this data. UnitedHealthcare uses statistical testing to compare a physician s results to expected or normative results. There is a risk of error in statistical tests when applied to the data and a result based on statistical testing is not a guarantee of correct inference or classification. We inform members that it is important that they consider many factors and information from as many sources as possible when selecting a physician. We also inform our members that they may wish to discuss designations with a physician before choosing him or her, or confer with their current physician for advice on selecting other physicians. The information contained in this Procedure Episode Groups (PEG ) Description and Specialty document is subject to change. Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, Inc., and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc. or its affiliates. M /14 UHC1905z_ ET United HealthCare Services, Inc.
Treatment Category Inpatient Treatment Categories DRG (MS DRG) ICD9 [Hip & Knee Only]
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NCCT List of Procedures Treatment Category Inpatient Treatment Categories DRG (MS DRG) ICD9 [Hip & Knee Only] Bariatric Surgery - Laparoscopic Gastric Bypass DRG - 288 MS DRG - 621 Cardiac Angioplasty
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Procedure. 2 29827 $ 3,560 $ 1,476 Arthroscopy, shoulder, surgical; with rotator cuff repair 5.5% 241.1%
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