UnitedHealth Premium Physician Designation Program Procedure Episode Groups (PEG ) Description and Specialty 30908 Coronary Artery Catheterization (Diagnostic) Cardiology 30508 Coronary Artery Catheterization (Therapeutic) Cardiology 30608 Coronary Artery Catheterization with Non Drug Stent with Acute Myocardial Infarction 30708 Coronary Artery Catheterization with Drug Stent with Acute Myocardial Infarction 30808 Invasive Therapeutic Electrophysiology (Ablation) Cardiology Cardiology Cardiology 30208 Implantable Device Defibrillator Cardiology 30308 Implantable Device Pacemaker Cardiology 70111 Appendectomy General Surgery 70212 Cholecystectomy General Surgery 83611 Diagnostic Colonoscopy General Surgery 70411 Esophagoplasty/Fundoplasty General Surgery 70711 Gastrointestinal Restrictive Procedure General Surgery 70911 Lower Gastrointestinal Removal General Surgery 71111 Lower Gastrointestinal Endoscopy with Treatment General Surgery 71511 Inguinal Hernia Repair General Surgery 71611 Incisional or Ventral Hernia Repair General Surgery 71711 Umbilical Hernia Repair General Surgery 71811 Upper Gastrointestinal Removal General Surgery 72011 Upper Gastrointestinal Endoscopy with Treatment General Surgery
70018 Achilles Tendon Repair Neurosurgery - Spine, Orthopaedics 70318 Ankle Ligament Repair Neurosurgery - Spine, Orthopaedics 70718 Arthroscopy of Ankle with Major Repair Neurosurgery - Spine, Orthopaedics 74218 Bunionectomy Neurosurgery - Spine, Orthopaedics 70918 Carpal Tunnel Release; Open Neurosurgery - Spine, Orthopaedics 71018 Carpel Tunnel Release (Arthroscopic) Neurosurgery - Spine, Orthopaedics 71118 Cervical Spine Fusion Neurosurgery - Spine, Orthopaedics 71118 Cervical Spine Fusion with Hardware Insertion Neurosurgery - Spine, Orthopaedics 71218 Cervical Spine Laminectomy Neurosurgery - Spine, Orthopaedics 71318 Vertebral Corpectomy Neurosurgery - Spine, Orthopaedics 74318 Repair Hammer Toe Neurosurgery - Spine, Orthopaedics 71518 Hip Replacement Neurosurgery - Spine, Orthopaedics 71518 Hip Replacement Revision Neurosurgery - Spine, Orthopaedics 71618 Therapeutic Arthroscopy of the Hip Neurosurgery - Spine, Orthopaedics 71918 Knee Replacement Surgery Neurosurgery - Spine, Orthopaedics 71918 Knee Replacement Surgery Revision Neurosurgery - Spine, Orthopaedics 72018 Knee Arthroscopy with Cruciate Ligament Repair Neurosurgery - Spine, Orthopaedics 72218 Knee Arthroscopy with Meniscectomy Neurosurgery - Spine, Orthopaedics 72318 Other Knee Arthroscopy with Treatment Neurosurgery - Spine, Orthopaedics 72418 Fusion (Lumbar Back) Neurosurgery - Spine, Orthopaedics 72418 Fusion (Lumbar Back) with Hardware Insertion Neurosurgery - Spine, Orthopaedics 72518 Decompression (Herniated Disc/Lumbar Back) Neurosurgery - Spine, Orthopaedics 72518 Lumbar Spine Revision Neurosurgery - Spine, Orthopaedics 72718 Arthrodesis (Midfoot) Neurosurgery - Spine, Orthopaedics 73218 Rotator Cuff Repair Neurosurgery - Spine, Orthopaedics 73418 Arthroscopic Decompression (Shoulder) Neurosurgery - Spine, Orthopaedics 73618 Arthroscopic Removal of Foreign Body/Debridement (Shoulder) Neurosurgery - Spine, Orthopaedics 73718 Shoulder Arthroscopy with Claviculectomy, Tenodesis or Capsulorrha Neurosurgery - Spine, Orthopaedics 73718 Shoulder Arthroscopy with Synovectomy or Lysis Adhesions Neurosurgery - Spine, Orthopaedics 73818 Arthroscopic Repair - Slap Shoulder Neurosurgery - Spine, Orthopaedics 73818 Arthroscopic Repair - Rotator Cuff Neurosurgery - Spine, Orthopaedics 90116 Colporrhaphy Obstetrics/Gynecology 90316 Cautery of Cervix Obstetrics/Gynecology 2
90416 Conization of Cervix Obstetrics/Gynecology 90616 Endometrial Ablation Obstetrics/Gynecology 90716 Excision of Ovary/Ovarian Duct Obstetrics/Gynecology 90816 Excision of Fibroid Tumor(S) of Uterus Obstetrics/Gynecology 91016 Hysteroscopy with Treatment Obstetrics/Gynecology 91116 Incision and Drainage of Bartholin's Gland Abscess Obstetrics/Gynecology 91316 Lysis and Adhesion of Ovary/Ovarian Duct Obstetrics/Gynecology 91616 Ovary/Ovarian Duct Removal Obstetrics/Gynecology 91716 Supracervical Hysterectomy Obstetrics/Gynecology 91814 Stress Incontinence Repair Obstetrics/Gynecology, Urology 91916 Total Abdominal Hysterectomy Obstetrics/Gynecology 92116 Vaginal Hysterectomy Obstetrics/Gynecology 10107 Aqueous Shunt To Extraocular Reservoir Ophthalmology 10207 Cataract Removal Ophthalmology 10307 Closure of the Lacrimal Punctum Ophthalmology 10407 Correction of Lid Ophthalmology 10607 Dacryocystorhinostomy Ophthalmology 10707 Destruction of Retina Ophthalmology 10807 Dilation of Lacrimal Punctum Ophthalmology 10907 Discission of Secondary Membranous Cataract Ophthalmology 11207 Exchange of Intraocular Lens Ophthalmology 11307 Excision and Repair of Eyelid Ophthalmology 11407 Excision of Lesion - Cornea Ophthalmology 11507 Excision or Transposition of Pterygium Ophthalmology 11707 Fistulization of Sclera for Glaucoma Ophthalmology 11807 Iridotomy/Iridectomy Ophthalmology 11907 Insertion of Intraocular Lens Prosthesis Ophthalmology 12007 Iridoplasty Ophthalmology 12107 Intravitreal Injection of a Pharmacologic Agent Ophthalmology 12207 Keratoplasty Ophthalmology 12307 Optic Nerve Decompression Ophthalmology 12407 Orbitotomy Ophthalmology 3
12507 Prophylaxis of Retinal Detachment Ophthalmology 12607 Probing of Nasolacrimal Duct Ophthalmology 12707 Removal of Foreign Body - External Eye Ophthalmology 12807 Operative Wound of Anterior Segment - Revision or Repair Ophthalmology 12907 Repair of Blepharoptosis Ophthalmology 13007 Repair of Ectropion Ophthalmology 13107 Repair of Brow Ptosis Ophthalmology 13207 Repair of Retinal Detachment Ophthalmology 13307 Strabismus Revision Ophthalmology 13407 Severing of Vitreous Strands Ophthalmology 13607 Trabeculoplasty By Laser Surgery Ophthalmology 13707 Vitrectomy Ophthalmology 50114 Insertion of Inflatable Urethral/Bladder Neck Sphincter Urology 50214 Cystourethroscopy with Treatment Urology 50314 Cystoplasty or Cystourethroplasty Urology 50414 Cystectomy Urology 50514 Cystorrhaphy Urology 50614 Transurethral Destruction of Prostate Tissue Urology 52914 Excision of Extraparenchymal Lesion of Testis Urology 53214 Exploration for Undescended Testis Urology 50914 Laser Coagulation Urology 51014 Litholapaxy Urology 51114 Lithotripsy Urology 51214 Laparoscopic Nephrectomy Urology 51314 Nephrectomy Urology 51414 Nephrolithotomy Urology 53714 Laparoscopic Orchiectomy Urology 53014 Orchiectomy - Partial Urology 53114 Orchiectomy - Radical Urology 53414 Orchiopexy Urology 52814 Prostatectomy - Radical Urology 52514 Prostatectomy - Subtotal Urology 52614 Exposure of Prostate/Insertion of Radioactive Substance Urology 4
52714 Laparoscopic Prostatectomy Urology 52414 Prostatotomy Urology 51514 Pyeloplasty Urology 51614 Renal Endoscopy with Treatment Urology 53514 Testicular Injury Suture or Repair Urology 51714 Renal Transplant Urology 53314 Reduction of Torsion of Testis - Surgical Urology 51814 Sling Operation for Correction of Male Urinary Incontinence Urology 51914 Transurethral Resection of Bladder Neck Urology 52014 Ureter-Bladder Anastomosis Urology 52114 Ureter-Intestine Anastomosis Urology 52214 Ureterolysis Urology 52314 Vesicourethropexy Urology 5
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. M49260 1/14 UHC1905z_20130919 ET120 013014 2014 United HealthCare Services, Inc.