CPT 21084 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 11 - Office • 19 - Off Campus Outpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 52 - Reduced Services • 51 - Multiple procedures • XS - Separate Structure • SC - Medically necessary service or supply • GA - Required ABN issued and on file |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21084 |
National average reimbursement for CPT 21084 by major payers:
$1,957.75
$2,246.24
$2,187.55
$2,732.17
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 21084 | ||||||
United | 21084 | $2014.00 | 1134182660 - CORAL SPRINGS SURGI-CENTER LTD | 650538147 - (FL) CORAL SPRINGS SURGICENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $4016.00 | 1962506618 - THE POLYCLINIC, ASC POLYCLINIC SURGERY CENTER | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $1570.00 | 1245233410 - SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC | 233022566 - (PA) SURGICAL SPECIALTY CENTER OF N | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $660.00 | 1043284508 - WINTER HAVEN-SEBRING FL OPHTHALMOLOGY ASC LLC, EYE SURGERY & LASER CENTER OF SEBRING | 743072437 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $2548.00 | 1922003052 - EAST OREGON SURGERY CENTER, LLC | 200209992 - (OR) EAST OREGON SUREGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $4010.00 | 1447355243 - SURGICENTER OF GREATER MILWAUKEE, LLC, SURGICENTER OF GREATER MILWAUKEE, INC. | 391682308 - (WI) CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $3190.00 | 1942230024 - LUTHERVILLE ENDOSCOPY CENTER LLC | 823193901 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $2450.00 | 1083384432 - NASHVILLE SURGICENTER, LLC | 474086590 - (TN) NASHVILLE SURGICENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $2454.00 | 1447220082 - WESTERN PA SURGERY CENTER, WEXFORD BRANCH, LLC, WESTERN PA SURGERY CENTER | 251826912 - (PA) WESTERN PA SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $1014.00 | 1528032711 - COLUMBIA ENDOSCOPY CENTER, LLC | 710923725 - (MO) COLUMBIA ENDOSCOPY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $5020.00 | 1861905176 - BERKSHIRE EYE, LLC | 352609003 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $2668.00 | 1629458427 - CLARKSVILLE SURGICENTER, LLC | 473830244 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $1700.00 | 1750597449 - OKLAHOMA LITHOTRIPTER ASSOCIATES, L.C., OKLAHOMA KIDNEY STONE CENTER | 731415771 - (OK) OKLAHOMA LITHOTRIPTER ASSOCIATES, LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $518.00 | 1003858721 - PIEDMONT ENDOSCOPY CENTER, INC. | 561634105 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21084 | $3882.00 | 1336665306 - EAGAN ORTHOPEDIC SURGERY CENTER LLC | 822364448 - (MN) EAGAN ORTHOPEDIC SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 21084 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21084 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 21084 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 21082-CPT | High | Impress Custom Prep Palatal Augmentation |
| 21083-CPT | High | Impress/Prep Palatal Lift Prosth |
| 21084-CPT | High | Impress Custom Prep Speech Aid Prosth |
| 21085-CPT | Moderate | Impression & Custom Preparation; Oral Surgical Splint -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21084. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21084 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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