UnitedHealthcare Outpatient Procedure Grouper Exhibit annual reimbursement update

Effective for dates of service beginning July 1, 2025, we will update the UnitedHealthcare Outpatient Procedure Grouper (OPG) Exhibit to define the CPT® and HCPCS code assignments to grouper levels. This exhibit determines reimbursement for outpatient procedures by listing valid codes and their eligible reimbursement levels.

What you need to do

• Review the updated Outpatient Procedure Grouper (OPG) Exhibits. The July exhibit list includes codes that were recently added and removed. Many codes remain the same:
  • 99.92% are assigned to the same grouper level
  • 0.08% have increased in level assignment 
  • 0.00% have decreased in level assignment
• Ensure you submit complete claims. When billing for outpatient procedures, please include the appropriate CPT, HCPCS and revenue codes. They’re required for reimbursement.