Outpatient Procedure Grouper mapping update

On July 1, 2021, the UnitedHealthcare Outpatient Procedure Grouper (OPG) Exhibit will be updated to reflect quarterly reimbursement for outpatient and other procedures.

To help ensure accurate reimbursement, please:

• Use the correct CPT^® code
• Include Healthcare Common Procedure Coding System (HCPCS) codes with revenue codes

Both CPT and HCPCS codes are required for reimbursement.

In relation to 2020 OPG mapping, 94.1% of codes continue to be assigned to the same grouper level, while 5.8% have increased and 0.1% have decreased assigned levels.

To view reimbursable OPG codes, visit the updated exhibit on the Claims, Billing and Payments page of UHCprovider.com. Simply look for the “View Outpatient Procedure Grouper (OPG) Exhibits” section. 

CPT^® is a registered trademark of the American Medical Association.

PCA-1-21-00729-E&I-News