Vhi – Enhanced Orthopaedic Care Pathway

Key Points to Note

  • Surgical Pathway & Reimbursement Info for Vhi Members.

  • You may need to pay for your initial consultation.

  • However, if a UPMC SSC consultant confirms that surgery is needed (ACL repair, hip or knee replacement), you’ll enter the surgical pathway and qualify for the enhanced reimbursement bundle.

  • The consultation confirming surgery will be fully covered.

Physiotherapy Sessions

Physiotherapy sessions provided in UPMC SSC or locally if living outside of Dublin.

  • ACL repair: Seven physiotherapy sessions

  • All knee replacements: Five physiotherapy sessions

  • All hip replacements: Two physiotherapy sessions

Surgical Care Pathway Details

Eligibility: By GP referral, Vhi members requiring ACL repair, hip replacement, or knee replacement.

Surgical Codes Covered:

  • ACL Codes – 3836, 3837 & 3838

  • Total Hip Replacement – 3660

  • Bilateral Hip Replacement – 3655

  • Total Knee Replacement – 3910

  • Bilateral Knee Replacement – 3909

  • Partial Knee Replacement – 3914 & 3943

  • Bilateral Partial Knee Replacement – 3917

Pathway Inclusions

  • One pre-operative consultation and one post-operative consultation fully covered when surgery is deemed necessary by an SSC consultant participating in the surgical pathway.

How You Are Covered

  • Full cover for two consultations with your surgeon and allocated physio sessions (excluding PublicPlus plans).

  • Surgery/procedure cover varies by plan: Full / 60% / 80% (PublicPlus plans excluded).

Entry Point to Surgical Pathway

A GP referral is required for Vhi members to access this service.

If a UPMC SSC consultant confirms that surgery is needed for ACL repair, hip replacement, or knee replacement, you’ll qualify for the enhanced reimbursement bundle.

If surgery isn’t needed, you can still access the non-surgical pathway — but consultations and physiotherapy will be self-funded.