UnitedHealthcare OPG Exhibit Flags Policy Update

OPG Eligibility and Exhibit Notification — Criteria Summary

OPG eligibility criteria

OPG eligibility status per code

OPG Exhibit Notification File values indicate code eligibility for OPG contract rates: 'Y' = eligible for a Contract Rate under OPG; 'N' = not eligible for a Contract Rate under OPG; 'UL' = Unlisted, eligible for the Unlisted Contract Rate under OPG.

OPG Exhibit Flags List (excerpt)

Listed codes and their Exhibit Notification File values (excerpt)

This excerpt lists procedure and miscellaneous codes alongside their 'Exhibit Notification File' value (Y/N or UL) and a brief descriptor; entries are code -> flag mappings without coverage criteria.

OPG entries (informational only)

This excerpt provides code-to-description mappings and a notification flag; it does not state coverage determinations or medical necessity criteria.

Entries show code, short description, and Exhibit Notification File flag (e.g., 00840 = ANESTH SURG LOWER ABDOMEN, Exhibit Notification File = N). These lines are informational only and do not define coverage or medical necessity.

Exhibit-notified codes

Codes flagged with exhibit notifications (examples)

Examples

0164T — Exhibit Notification File = Y; numeric field = 0; descriptor = REMOVE LUMB ARTIF DISC ADDL.
0165T — Exhibit Notification File = Y; numeric field = 0; descriptor = REVISE LUMB ARTIF DISC ADDL.
0184T — Exhibit Notification File = Y; numeric field = 4; descriptor = EXC RECTAL TUMOR ENDOSCOPIC.

Non-exhibit-notified codes

Codes without exhibit notification (flag = N) — examples from excerpt

Many anesthesia and U-code (molecular/genetic) entries in the excerpt are assigned Exhibit Notification File = N (e.g., 01270, 01272, 0129U, 01320). These N entries indicate no OPG exhibit notification for those codes in this file.

OPG notification mapping (excerpt)

OPG exhibit entries and their notification flags

Each line maps a procedure code to an Exhibit Notification File flag (Y or N) and a short descriptor; some Y entries include an additional numeric or 'UL' field (e.g., 0201T = Y, value 4; 0202T = Y, value 6).

OPG exhibit notification flag criteria

Interpretation rule: Exhibit Notification File = 'Y' indicates the code is flagged in the OPG exhibit (requires exhibit notification/handling); 'N' indicates the code is not flagged in the exhibit file. Some Y entries include an additional numeric/UL value representing a supplemental exhibit parameter.

Exhibit notification listing (no coverage criteria)

This excerpt contains per-code Exhibit Notification File assignments (code -> flag/value) and does not include medical necessity or coverage decision language; entries are informational mapping lines only.

Observed exhibit flag patterns

Observed exhibit flag patterns in the excerpt

ALL of the following

Many U-code entries (molecular/genomic/diagnostic tests) are followed by Exhibit Notification File = N (examples shown across multiple entries).
Many T-code procedural entries are marked Exhibit Notification File = Y, often with a supplemental numeric or 'UL' value (examples: 0474T = Y, value 5; 0480T = Y, value 0; 0494T = Y, value UL).
This module records observed flag patterns but does not assert coverage; flags may reflect internal grouping, routing, or prior-notification processes.

OPG exhibit line format

Exhibit lines associate codes with notification flags and occasional numeric limits or notes

Line format:

, UHC OPG (Outpatient Procedure Grouper) Exhibit Notification File = . , UHC OPG (Outpatient Procedure Grouper) Exhibit Notification File =  [optional numeric/UL value]. Example group: 0520F = N; 0520T = Y, value 10; 0521T = N.

Exhibit Notification Flag Criteria

Indicator mapping for codes in this excerpt

Sample mapping (selected codes): 0571T = Y (value 10); 0572T = Y (value 7); 0573T = Y (value 4); 0576T = N. The presence of 'Y' indicates the code is included/flagged in the Exhibit Notification File; 'N' indicates not flagged.

OPG per-code flag entries — informational

OPG per-code flag entries — informational (no coverage determinations)

This excerpt lists per-code Exhibit Notification File flags (Y/N or UL and occasional numeric qualifiers) paired with short descriptors (e.g., 0643T = Y, UL; 0658T = N). These entries document notification status for outpatient processing but do not establish medical necessity or coverage decisions.

OPG Exhibit Flag Entries

OPG Exhibit Flag Entries — entries are flag assignments only

Entries map codes to an Exhibit Notification File flag (Y/N/UL) and sometimes a supplemental value; no medical necessity or coverage criteria are included in these lines.

OPG exhibit notification examples

Selected examples of OPG exhibit notification values indicating grouping or allowance behavior

Examples

0861T — Exhibit Notification File = Y; value = 4; descriptor = REMOVAL PG WCS LV PACING BOTH COMPONENTS.
0862T — Exhibit Notification File = Y; value = 2; descriptor = RELOCATION PG WCS LV PACG BATTERY COMPONENT ONLY.
0870T — Exhibit Notification File = Y; value = UL; descriptor = IMPLANTATION SUBQ PERITONEAL ASCITES PUMP SYS.
0875T — Exhibit Notification File = N (example of negative flag).
0926T — Exhibit Notification File = N (example of negative flag).

`Codes and Exhibit Notification Flags (sample listings)`

Sample CPT/HCPCS-like codes from exhibitmixed

0001F	HEART FAILURE COMPOSITE
0001U	RBC DNA HEA
00100	ANESTH SALIVARY GLAND
0036U	EXOME TUMOR TISSUE & NORMAL SPECIMEN SEQ ALYS
0048U	ONC SLD ORG NEO DNA 468 CANCER ASSOCIATED GENES

Examples of molecular/serology OPG entriesCPT

0042U	B BURGDORFERI ANTB 12 PRTN GRP IMMUNOBLOT IGG
0043U	TBRF B GRP ANTB DETCJ 4 RECOMB PRTN IMUNOBLT IGM
0044U	TBRF B GRP ANTB DETCJ 4 RECOMB PRTN IMUNOBLT IGG

Examples of 'T' category OPG entries with Y flagsCPTCovered

0054T	BONE SURGERY USING COMPUTER
0055T	BONE SURGERY USING COMPUTER
0071T	U/S LEIOMYOMATA ABLATE <200

Sample OPG entries from excerptmixed

00840	ANESTH SURG LOWER ABDOMEN
00842	ANESTH AMNIOCENTESIS
00844	ANESTH PELVIS SURGERY
00846	ANESTH HYSTERECTOMY
00848	ANESTH PELVIC ORGAN SURG
0084U	Red blood cell antigen typing, DNA, genotyping of
00851	ANESTH TUBAL LIGATION
0100T	PROSTH RETINA RECEIVE&GEN
0101T	EXTRACORPOREAL SHOCK WAVE MUSCSKEL SYS NOS
01200	ANESTH HIP JOINT PROCEDURE

1–10 of 121/2

sample anesthesia and genetic test codes with OPG flagsmixed

01270	ANESTH FEMORAL ARTERY SURG
01272	ANESTH FEMORAL EMBOLECTOMY
0129U	HEREDITARY BRST CA RLTD DO GEN SEQ&DEL/DUP PNL

example molecular/diagnostic U-codesmixed

0140U	NFCT DS FUNGAL PATHOGEN ID DNA 15 FUNGAL TARGETS
0152U	NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ
0153U	ONC BREAST MRNA GENE EXPRESSION PRFL 101 GENES

sample procedure and temporary/misc codes in excerptmixed

01820	ANESTH LOWER ARM PROCEDURE
01829	ANESTH DX WRIST ARTHROSCOPY
0182U	CROM GNOTYP GENE ANALYSIS CD55 EXONS 1-10 (U-code)
01830	ANESTH LOWER ARM SURGERY
01832	ANESTH WRIST REPLACEMENT
0183U	DI GNOTYP GENE ANALYSIS SLC4A1 EXON 19 (U-code)
0184T	EXC RECTAL TUMOR ENDOSCOPIC (T-code)
0200T	PERQ SACRAL AUGMT UNILAT INJ (T-code)
0201T	PERQ SACRAL AUGMT BILAT INJ (T-code)
0202T	POST VERT ARTHRPLST 1 LUMBAR (T-code)

Selected U/T codes with exhibit flagsCPT | HCPCS | mixed

0224U	ANTB SEV AQT RESPIR SYND CORONAVIRUS 2 TITER(S); Exhibit Notification File = N
0225U	NFCT DS DNA&RNA 21 TARGETS SARS-COV-2 AMP PROBE; Exhibit Notification File = N
0232T	NJX PLATELET PLASMA; Exhibit Notification File = Y, value 0
0234T	TRLUML PERIP ATHRC RENAL ART; Exhibit Notification File = Y, value 7
0253T	INSERT AQUEOUS DRAIN DEVICE; Exhibit Notification File = Y, value 5
0263T	IM AUTOL B1 MRW CEL THER 1 LEG COMPL INCL HRVST; Exhibit Notification File = Y, value 5
0264T	IM AUTOL B1 MRW CEL THER 1 LEG COMPL XCL HRVST; Exhibit Notification File = Y, value 5
0265T	IM AUTOL B1 MRW CEL THER UNI/BI HRVST ONLY; Exhibit Notification File = Y, value 5
0266T	IMPLTJ/RPLCMT CRTD SNS BRORFLX ACTV DEV TOT SYS; Exhibit Notification File = Y, value 9
0274T	PERQ LAMOT/LAM ANY METH SINGLE/MLT LVL CRV/THRC; Exhibit Notification File = Y, value 6

1–10 of 131/2

Selected codes flagged YCPTCovered

0308T	INSJ OCULAR TELESCOPE PROSTH (OPG Exhibit Notification File = Y, flag 9)
0335T	EXTRA-OSSEOUS JOINT IMPLANT TALOTARSAL STABILJ (OPG Exhibit Notification File = Y, flag 3)
0338T	TRANSCATHETER RENAL SYMPATH DENERVATION UNILAT (OPG Exhibit Notification File = Y, flag 4)
0339T	TRANSCATHETER RENAL SYMPATH DENERVATION BILAT (OPG Exhibit Notification File = Y, flag 4)
0342T	THERAPEUTIC APHERESIS W/ SELECTIVE HDL DELIP (OPG Exhibit Notification File = Y, flag 5)
0345T	TRANSCATH MITRAL VALVE REPAIR VIA CORONARY SINUS (OPG Exhibit Notification File = Y, flag UL)
0347T	PLACE INTERSTITIAL DEVICE(S) IN BONE FOR RSA (OPG Exhibit Notification File = Y, flag 0)
0397T	ERCP WITH OPTICAL ENDOMICROSCOPY ADD ON (OPG Exhibit Notification File = Y, flag 0)

Selected T- and U-code entries from listmixed

0391U	UHC OPG exhibit notification entry; description text present in chunk 126
0397T	ERCP WITH OPTICAL ENDOMICROSCOPY ADD ON; Exhibit Notification = Y (chunk 127)
0402T	COLLAGEN CROSS-LINKING CORNEA & PACHYMETRY; Exhibit Notification = Y (chunk 128)
0412T	REMOVAL CARDIAC MODULATION SYSTEM PULSE GENERATOR ONLY; Exhibit Notification = Y (chunk 131)
0443T	R-T SPECTRAL ANALYSIS PRST8 TISSUE FLUORESCENCE SPECTROSCOPY; Exhibit Notification = Y (chunk 139)

Sample OPG CPT/HCPCS-like codes with exhibit flags present in this excerptmixed

0464T	OPG entry with text fields (0464T) and associated exhibit notification values
0474T	INSJ ANT SEG AQUEOUS DRG DEV W/IO RSVR (marked Y; numeric 5)
0479T	FRACTIONAL ABL LSR FENESTRATION FIRST 100 SQCM (marked Y; numeric 1)
0481T	NJX AUTOL WBC CONCENTR INC IMG GDN HRV & PREP (marked Y; numeric 0)
0494T	PREP & CANNULJ CDVR DON LNG ORGN PRFUJ SYS (marked Y; UL)
0510T	REMOVAL OF SINUS TARSI IMPLANT (marked Y; numeric 4)
0511T	REMOVAL AND REINSERTION OF SINUS TARSI IMPLANT (marked Y; numeric 3)
0512T	ESW INTEGUMENTARY WOUND HEALING INITIAL WOUND (marked Y; numeric 0)

OPG codes in this segmentCPT

0520F	UHC OPG Exhibit Notification File entry (example line present)
0576T	UHC OPG Exhibit Notification File entry (terminal line in this window)

Selected T-codes flagged Y in OPGCPTCovered

0571T	INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE; Exhibit Notification File = Y
0572T	INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD; Exhibit Notification File = Y
0573T	RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD; Exhibit Notification File = Y
0580T	RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY; Exhibit Notification File = Y
0614T	RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG; Exhibit Notification File = Y

Sample T-codes from excerptCPT

0639T	OPG Exhibit Notification File entry
0640T	OPG Exhibit Notification File entry
0643T	Transcatheter L ventricular restoration device implantation (OPG entry shown)

sample listed codes in excerptCPT

0743T	0743T entry present in list
0780T	INSTLJ FECAL MICROBIOTA SSP RCT NMA LWR GI TRC
0810T	SUBRETINAL NJX RX AGT W/VTRC & 1+ RETINOTOMIES
0845T	DGTZ GLS MCRSCP SLD IMFLUOR 1ST SINGLE ANTB STN
0855T	DGTZ GLS MCRSCP SLD BONE MARROW SMEAR INTERPJ

Sample CPT Category III / temporary procedure codes presentCPT

0845T	DGTZ GLS MCRSCP SLD IMFLUOR 1ST SINGLE ANTB STN
0861T	REMOVAL PG WCS LV PACING BOTH COMPONENTS
0870T	IMPLANTATION SUBQ PERITONEAL ASCITES PUMP SYS
0926T	PROGRAMMING DEVICE EVAL IMPL CCM-D SYS IN PERSON
0950T	ABLTJ B9 PRST8 TISSUE TRANSRECTAL HIFU W/US GDN

Sample CPT/HCPCS codes presentCPT

0943T	CYSTO FLX REMOVAL PROSTATIC URETHRAL SCAFFOLD
0944T	3D CONTOUR SIMULAJ TRGT LVR LES&MRGN MICRWV ABLT
10005	FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
11042	listed near document end (code present in this segment)

inv-32: OPG Exhibit Notification Flag — Values include Y (with numeric or short flag) or N (no notification)

Field nameOPG Exhibit Notification Flag

Possible valuesY or N (flag appears alongside each code)

Actionable meaningY = code is flagged for OPG exhibit notification (may affect outpatient grouper handling); N = not flagged for exhibit notification

Format notesSome entries show an additional numeric or short supplemental field following the Y flag (e.g., 'Y, 0', 'Y, 4')

inv-33: Exhibit numeric field — Some Y entries include a numeric value adjacent to the Y flag indicating an internal code or count.

Field nameExhibit numeric field

Examples0402T Exhibit Notification File = Y, value 3; 0397T = Y, value 0; 0308T = Y, value 9

InterpretationNumeric values (e.g., 0,1,3,4,5,7,9,10) appear adjacent to some Y flags and likely represent an internal exhibit qualifier or grouping/count

inv-34: Exhibit Notification File possible values — Y (yes), N (no), UL, numeric codes or blank

Field nameExhibit Notification File possible values

Observed valuesY, N, UL, numeric codes (e.g., 3, 4, 7, 10) or blank

Note'UL' appears where an unlisted/alternate grouping is indicated (e.g., 0643T = Y, value UL; 0943T = Y, value UL)

inv-35: Exhibit Notification flag types — Y, N, ., UL, numeric indicators

Field nameExhibit Notification flag types

Values observedY, N, . (blank), UL, numeric indicators (examples: 0,1,2,3,4,5,6,7,9,10)

ImplicationCombination of Y with numeric/UL indicates additional exhibit attributes; '.' or blank denotes no supplemental value

`Billing and Provider Guidance — What Providers Must Know`

NoteOPG exhibit flag guidance
UHC maintains an Outpatient Procedure Grouper (OPG) Exhibit Notification File that flags CPT/HCPCS codes for OPG contract-rate eligibility and exhibit handling. Flags include Y (eligible/notify), N (not eligible/no exhibit), UL (Unlisted), and numeric or text supplemental values that provide additional exhibit instructions. Providers should use this file to determine billing behavior and whether an exhibit notification applies to a procedure.
Y = Yes — eligible for a Contract Rate under OPG and flagged in the Exhibit Notification File.
N = No — not flagged in the Exhibit Notification File.
UL = Unlisted — code present but marked unlisted in the Exhibit Notification File.
Supplemental numeric/text values (e.g., 0, 3, 7, UL) provide additional exhibit handling or grouping details.

Billing RuleOPG exhibit flag examples
Example entries showing OPG exhibit flags for specific T-codes illustrate how codes are marked in the file and any supplemental values.
0054T — UHC OPG Exhibit Notification File = Y; supplemental value = 0 (BONE SURGERY USING COMPUTER).
0055T — UHC OPG Exhibit Notification File = Y; supplemental value = 0 (BONE SURGERY USING COMPUTER).
0071T — UHC OPG Exhibit Notification File = Y; supplemental value = 3 (U/S LEIOMYOMATA ABLATE <200).
0072T — UHC OPG Exhibit Notification File = Y; supplemental value = 3 (U/S LEIOMYOMATA ABLATE >200).

NoteOPG exhibit flag with note
Some OPG exhibit flags include supplemental notes or numeric values indicating special exhibit handling.
0071T — Exhibit Notification File = Y; note/value = 3.
0072T — Exhibit Notification File = Y; note/value = 3.
0184T — Exhibit Notification File = Y; note/value = 4 (EXC RECTAL TUMOR ENDOSCOPIC).

NoteOPG exhibit notification flags (no PA stated)
The file lists many OPG exhibit notification flags where no explicit prior authorization (PA) is stated in the extract; Y/N simply indicates whether the code is flagged for exhibit handling under the OPG.
Multiple anesthesia, laboratory, and procedure codes are marked N (no exhibit notification) throughout the extract.
Many Category III/T codes and other procedural codes are marked Y with supplemental values — these are exhibit notifications, not explicit PA requirements in this excerpt.

Billing RuleOPG flags for 0164T, 0165T, 0184T
Select specific code flags called out in the source:
0164T — UHC OPG Exhibit Notification File = REMOVE LUMB ARTIF DISC ADDL; Exhibit Notification File = Y; supplemental value = 0.
0165T — UHC OPG Exhibit Notification File = REVISE LUMB ARTIF DISC ADDL; Exhibit Notification File = Y; supplemental value = 0.
0184T — UHC OPG Exhibit Notification File = EXC RECTAL TUMOR ENDOSCOPIC; Exhibit Notification File = Y; supplemental value = 4.

NoteOPG notification flags (Y/N) — selected examples
The Exhibit Notification File contains both Y and N flags across many T- and U-codes; examples show Y flags for selected T-codes and many U-codes marked N.
Examples of Exhibit Notification File = Y for T‑codes: 0234T (value 7), 0235T (value UL), 0236T (value 7), 0308T (value 9), 0397T (value 0).
Examples of Exhibit Notification File = N for U‑codes: 0234U, 0235U, 0236U, 0242U, 0243U (various genomic and lab analyses).

NoteOPG exhibit notification entries (partial)
Partial listing highlights how the file assigns exhibit notifications and supplemental values across a broad set of codes; Y indicates an exhibit notification.
0308T — Exhibit Notification File = Y; supplemental value = 9 (INSJ OCULAR TELESCOPE PROSTH).
0397T — Exhibit Notification File = Y; supplemental value = 0 (ERCP WITH OPTICAL ENDOMICROSCOPY ADD ON).
0474T — Exhibit Notification File = Y; supplemental value = 5 (INSJ ANT SEG AQUEOUS DRG DEV W/IO RSVR).
0480T — Exhibit Notification File = Y; supplemental value = 0 (ABL LSR FENESTRATION EA ADDL 100 SQCM).

NoteOPG exhibit notification entries (sample)
Additional sample entries from the extract showing Y/N exhibit notification file markings across procedures and devices.
0516T, 0517T — Exhibit Notification File = Y; supplemental value = 7 for both (cardiac device procedures).
0520T — Exhibit Notification File = Y; supplemental value = 10 (RMVL&RPLCMT PG WCS LV PACG BATTERY COMPNT ONLY).
0571T–0573T — Multiple ICD/ICD‑lead insertion/removal procedures flagged Y with numeric supplemental values.

NoteOPG Exhibit Notification flags (excerpt)
Excerpted OPG Exhibit Notification flags demonstrate broad usage for cardiac, valve, implantable device, and other high‑acuity procedures.
0483T — TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH = Y.
0643T–0646T — Various transcatheter ventricular and valve procedures = Y (some with UL or numeric values).
0801T–0803T — TCAT removal/replacement permanent pacemaker entries = Y with value 7.

NoteExample exhibit notification for Fecal Microbiota Transplant
Example: fecal microbiota transplant is explicitly listed and flagged in the OPG Exhibit Notification File.
0780T — UHC OPG Exhibit Notification File = INSTLJ FECAL MICROBIOTA SSP RCT NMA LWR GI TRC; Exhibit Notification File = Y; supplemental value = 0.

Billing RuleCardiac/valve and device procedure flags
Cardiac, valve, and implantable device procedures are frequently flagged Y and may carry supplemental exhibit values indicating grouping or handling instructions.
0483T, 0516T, 0517T, 0520T, 0571T–0573T, 0643T–0646T, 0801T–0805T — multiple entries flagged Y with numeric or UL supplemental values.
These flags indicate OPG exhibit handling for complex cardiac and device procedures; providers should reference the Exhibit Notification File for billing specifics.

NoteOPG negative flags
The extract includes many negative (N) flags — codes not flagged in the Exhibit Notification File — across anesthesia, lab/genomic U‑codes, and certain procedure categories.
Examples of N flags: numerous anesthesia codes (e.g., 00546, 00548, 00550), many U‑codes for genomic testing (e.g., 0054U, 0234U, 0235U, 0242U), and selected T‑codes (e.g., 00700 = N).
An N flag means the code is not designated in the Exhibit Notification File for OPG exhibit handling.

Prior AuthorizationProvider action: consult the OPG Exhibit Notification File
Overall provider action: consult the UHC OPG Exhibit Notification File to determine whether a CPT/HCPCS code is flagged (Y) or not (N) for OPG exhibit handling and to view any supplemental numeric or textual exhibit values that affect billing; the presence of a Y flag signals exhibit handling under the OPG but does not, in this extract, by itself denote a separate prior authorization requirement — providers should check plan-specific PA rules where applicable.
Use the Exhibit Notification File to decide billing behavior and contract-rate applicability.
When a code is marked Y, review any supplemental value or note for exhibit handling instructions.
If unsure whether exhibit notification implies prior authorization for a specific product line or member, confirm with UnitedHealthcare prior authorization guidelines.

`Key Terms and Flag Definitions`

inv-59: OPG eligibility flags — Y = Yes eligible for a Contract Rate under OPG; N = No; UL = Unlisted eligible for Unli...

YYes — eligible for a Contract Rate under OPG

NNo — not eligible for a Contract Rate under OPG

ULUnlisted — eligible for the Unlisted Contract Rate under OPG

inv-60: Exhibit Notification File (OPG flag) — UHC OPG indicator (Y/N or numeric note) assigned to procedure codes in this list

FieldExhibit Notification File (OPG flag) — per-entry indicator assigned to procedure codes

Typical contentShows a UHC OPG indicator per code (Y/N) and, when present, an adjacent numeric or textual note

PurposeUsed by UnitedHealthcare to denote Outpatient Procedure Grouper exhibit status for claim processing

inv-61: UHC OPG Exhibit Notification File — mapping of procedure codes to a notification flag (Y/N) and brief descriptor

DescriptionMapping of procedure codes to an Exhibit Notification File flag (Y or N) with brief descriptors in the file

Examples0397T = ERCP WITH OPTICAL ENDOMICROSCOPY ADD ON (Exhibit Notification File = Y, 0); 0308T = INSJ OCULAR TELESCOPE PROSTH (Y, 9)

NoteMany entries are informational and do not by themselves assert coverage determination; they record OPG exhibit status

inv-62: OPG (Outpatient Procedure Grouper) Exhibit Notification File — label for the dataset

LabelOPG (Outpatient Procedure Grouper) Exhibit Notification File

ContentList of codes with short descriptions and an Exhibit Notification File flag/value (Y/N and occasional numeric/UL values)

UseReference for providers and billing to determine OPG exhibit assignment for outpatient procedures

inv-63: 'Exhibit Notification File = Y/N' with additional numeric field where present

PatternMany lines show 'Exhibit Notification File = Y' or '... = N' with some Y entries followed by a numeric field

FormattingWhen present, the numeric field appears immediately after the Y flag (e.g., '0184T ... = Y. 0184T ... = 4')

ImplicationNumeric field likely encodes an internal exhibit attribute or grouping limit

inv-64: UHC OPG Exhibit Notification File — descriptor

DescriptorUHC OPG Exhibit Notification File — payer-maintained code-to-flag listing

Common entry elementsCode, short description, Exhibit Notification File flag (Y/N), optional numeric or UL supplemental value

ScopeIncludes CPT Category III, temporary T- and U-codes and other HCPCS-like entries

inv-65: Notification flag / exhibit field — 'Y' or 'N' values indicate the notification flag assigned to the listed code; numeric values following some 'Y' entries

FieldNotification flag / exhibit field (per-entry)

Values'Y' or 'N' appear for each code; some 'Y' entries are followed by numeric/UL supplemental values

InterpretationIndicates whether the code is included in the OPG exhibit notification set and any supplemental grouping parameter

inv-66: UHC OPG — payer-maintained flag (Y/N) and optional numeric value for U- and T- codes

ScopeUHC OPG uses a payer-maintained flag (Y/N) plus optional numeric values for many U- and T- codes in the file

Examples0412T = Y, 4; 0414T = Y, 10; many U-codes listed as N

NoteNumeric qualifiers vary by entry and may indicate internal grouping, limits, or routing attributes

inv-67: OPG exhibit notification indicator — OPG = Y/N

IndicatorOPG exhibit notification indicator = Y or N per code

UsageUsed to flag codes for special exhibit handling in UnitedHealthcare's outpatient grouper

FormatOften accompanied by a short description and, when present, a supplemental numeric or UL value

inv-68: 'Exhibit Notification File = Y/N' with additional numeric field where present (examples)

DisplayPer-entry 'Exhibit Notification File = Y' or '... = N' shown next to procedure codes

Supplemental fieldSome Y entries include a following numeric value (e.g., 0397T = Y, 0; 0402T = Y, 3)

Provider notePresence of Y does not itself define coverage; it signals exhibit/grouping status used in claim processing

inv-69: CPT Category III/T/U code entries — when marked 'Y' they appear to require special exhibit notification handling

Code typesIncludes CPT Category III, temporary T-codes, and U-codes (HCPCS-like) in the listing

ImplicationWhen marked 'Y' these codes are handled as exhibit-notified by the grouper; many U-codes are 'N'

Example0394T listed with flag N; 0397T listed with flag Y

inv-70: U-code — HCPCS Level II miscellaneous (per-entry indicator examples)

Per-entry indicatorY or N shown alongside each procedure code to denote exhibit status

Most actionable'Y' entries often include a numeric/UL supplemental value — treat presence of 'Y' + value as exhibit-notified with qualifier

Example0397T = Y, 0; 0402T = Y, 3; 0308T = Y, 9

inv-71: Per-entry indicator (Y or N) shown alongside procedure codes to denote exhibit status

Per-entry indicatorY or N displayed for each code to denote exhibit status

Observed patternMany procedural T-codes show 'Y' and many molecular/diagnostic U-codes show 'N'

Provider implicationUse this listing to determine which outpatient codes are in UHC's OPG exhibit set

inv-72: Supplemental values appearing with some entries (examples: UL, 0, 1, 3, 4, 5, 7, 10) representing limits or grouped attributes

Supplemental valuesExamples observed: UL, 0, 1, 3, 4, 5, 6, 7, 9, 10

MeaningLikely represent limits, grouping attributes, or internal qualifiers associated with the exhibit entry

Examples in file0474T = Y, 5; 0481T = Y, 0; 0516T = Y, 7

inv-73: OPG Exhibit Notification File entries: each line pairs an OPG code with a short descriptor and an Exhibit flag

StructureEach line pairs an OPG code with a short descriptor and an Exhibit Notification File flag/value

Primary useCaptures OPG exhibit status for outpatient procedure grouping and billing processing

LimitationThe file lists flags only and does not itself state medical necessity or coverage criteria

inv-74: UHC OPG OPG Exhibit Notification File — payer-maintained flag indicating inclusion in UnitedHealthcare's OPG exhibit

Payer flagUHC OPG Exhibit Notification File is a payer-maintained flag indicating inclusion in UnitedHealthcare's OPG exhibit

EffectFlags may affect outpatient grouper routing, contract rate eligibility, and internal processing

ExamplesMultiple T-codes flagged Y (e.g., 0520T = Y, 10) while many U-codes are N

inv-75: OPG Exhibit Notification File flag indicating UHC outpatient procedure grouper handling (Y/N/other)

Flag optionsY, N, UL, numeric qualifiers or blank entries

Observed usageUsed to indicate whether UHC's outpatient procedure grouper assigns exhibit notification/grouping treatment to the code

Provider guidanceConsult the exhibit file to determine OPG exhibit assignment before billing outpatient procedures

inv-76: UHC OPG exhibit notification — descriptor for exhibit entries

DescriptorUHC OPG exhibit notification — dataset mapping codes to exhibit flags and optional qualifiers

Most actionablePresence of 'Y' (especially when with a numeric/UL value) signals the code is exhibit-notified and may be subject to grouping/contract-rate logic

Examples0861T = Y, 4; 0643T = Y, UL; 0520T = Y, 10

inv-77: Exhibit notification flag values — 'Y' or 'N' and occasional supplemental text or numeric fields correspond to internal grouper attributes

Value setFlag values shown as 'Y' or 'N' and occasional supplemental text or numeric fields (e.g., UL, 7, 4, 0, 5)

Practical meaning'Y' indicates exhibit notification; 'N' indicates no exhibit notification. Supplemental values modify the Y flag behavior

Examples0780T = Y, 0; 0680T = Y, 7; many U-codes = N

inv-78: OPG exhibit notification — UHC OPG entry

Entry typeOPG exhibit notification — per-code entry in UHC's list

Example0861T = REMOVAL PG WCS LV PACING BOTH COMPONENTS (Exhibit Notification File = Y, 4)

NoteEntries include both procedural T-codes and laboratory/molecular U-codes; treatment varies by flag

inv-79: OPG exhibit notification flag indicating UHC outpatient procedure grouper handling or special notification

FunctionOPG exhibit notification flag indicates UHC outpatient procedure grouper handling or special notification for listed codes

Most actionableCheck for 'Y' (with optional numeric/UL qualifier) to identify codes that require exhibit handling in claims processing

Common observationsMany T-codes flagged Y; many U-codes flagged N; qualifiers include UL or numeric values

OpenPayer

UHC Outpatient Procedure Grouper (OPG) Exhibit — CPT/HCPCS OPG eligibility

OPG Eligibility and Exhibit Notification — Criteria Summary

`Codes and Exhibit Notification Flags (sample listings)`

`Billing and Provider Guidance — What Providers Must Know`

`Key Terms and Flag Definitions`