The UnitedHealthcare Outpatient Procedure Grouper (OPG) Exhibit that defines the CPT and Healthcare Common Procedure Coding System (HCPCS) code assignment to Grouper level will be updated on July 1, 2019. The OPG Exhibit is used to determine reimbursement for outpatient procedures and other issues.
When billing for outpatient procedures, please include the appropriate CPT and HCPCS codes with the revenue codes. These codes are required for reimbursement. Codes eligible for reimbursement under the OPG can be found in the 2018 UnitedHealthcare OPG Exhibit at UHCprovider.com/claims > View Outpatient Procedure Grouper (OPG) Exhibits.
Many codes remain the same as the 2018 OPG mapping: 99.5 percent are assigned to the same grouper level; 0.2 percent have increased in level assignment; and 0.3 percent have decreased in level assignment.
If you have any questions, please contact your Network Management representative.