Outpatient Surgical Procedure-Related Group (PRG) List

The HMSA Outpatient Surgical Procedure-Related Groups (PRG) List is a list of outpatient surgical procedures organized by designated CPT-4 codes with a description of the service and associated PRG grouper number. When a procedure is performed in an appropriate outpatient setting, reimbursement will be determined by the PRG grouper to which it has been assigned. A procedure is considered appropriate for an outpatient surgical setting if it satisfies both of the following criteria:

• Requires the higher level services of the OR
• Requires the services of the recovery room

The list is not all-inclusive but represents those procedures with the highest volume. If you are planning to provide a service/procedure that is not included on this list, please send a written request for a PRG assignment to the address listed below. The final assignment will be made once the claim is submitted along with the operative report.

HMSA – Provider Operations
Research and Correspondence
P.O. Box 860
Honolulu, HI  96808-0860

Cosmetic procedures are identified with a double asterisk (**), however, the entries do not represent a comprehensive list of those procedures. The symbol will assist providers in identifying procedures that HMSA has determined to be cosmetic in nature and may not be covered.

Please note:

Effective Feb. 1, 2015, all mandatory office procedures that had grouper assignments were removed from the Outpatient Surgical Procedure-Related Group (PRG) List posted in the Provider Resource Center. If circumstances warrant that an office procedure be done in a higher setting, please contact HMSA to precertify the service. Mandatory office procedures can be found under  Place of Treatment - Office Procedures List.

Access the current HMSA Outpatient Surgical Procedure-Related Groups (PRG) List.

2026 Outpatient Surgical Procedure-Related Group (PRG) List [XLSX] - 07/2026

Access the archived PRG Lists.

Revision History