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See a sample rate comparisonCPT 21084 Fee Schedule
Medicare rates as of October 2026
CPT 21084 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Custom Artificial Palate, A Prosthesis Made For The Roof Of The Mouth (Palate) From A Cast Model Of Impressions. It Is Used To Restore Oral Functions Such As Chewing Swallowing And Speech.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 19Off Campus Outpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | 52Reduced Services 51Multiple procedures XSSeparate Structure SCMedically necessary service or supply GARequired ABN issued and on file |
| Hospital Outpatient Group (APC) | APC 5164 - Level 4 ENT Procedures |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 03600761 |
| Medicare Fee Schedule | $1,610.59 national non-facility rate (2026)View Medicare rates for 21084 |
| Medicaid Fee Schedule | $1,250.095 median of the 8 states in the free previewView Medicaid rates for 21084 |
National average reimbursement for CPT 21084 by major payers:
$1,957.75
BCBS / Anthem
$2,246.24
UnitedHealthcare
$2,187.55
Aetna
$2,167.82
Cigna
Compare published rates across providers.
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CPT 21084
5 of 25 sample ratesHigher to lower in this preview
Bethesda Chevy Chase Surgery Center, LLC
Bethesda Chevy Chase Surgery Cen
$5,249.00Published rateEagan Orthopedic Surgery Center LLC
$3,882.00Published rateClarksville Surgicenter, LLC
$2,668.00Published rateCoral Springs Surgi-Center Ltd
Coral Springs Surgicenter Ltd
$2,014.00Published ratePiedmont Endoscopy Center, Inc.
$518.00Published rate
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See a sample payer proposalCPT 21084 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21084. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21082-CPT | Custom Artificial Palate, A Prosthesis Made For The Roof Of The Mouth (Palate) From A Cast Model Of Impressions. It Is Used To Restore Oral Functions Such As Chewing Swallowing And Speech. |
| 21083-CPT | Custom Artificial Palate, A Prosthesis Made For The Roof Of The Mouth (Palate) From A Cast Model Of Impressions. It Is Used To Restore Oral Functions Such As Chewing Swallowing And Speech. |
| 21084-CPT | Custom Artificial Palate, A Prosthesis Made For The Roof Of The Mouth (Palate) From A Cast Model Of Impressions. It Is Used To Restore Oral Functions Such As Chewing Swallowing And Speech. |
| 21085-CPT | Prepare Mouth Prosthesis, Creation Of A Prosthesis For The Mouth From A Cast Model Of Impressions. It Is Used In Jaw Surgery And Repair Of Facial Injuries. |
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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Frequently Asked Questions
What APC is CPT 21084 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21084 to APC 5164 (Level 4 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21084 in an ambulatory surgery center?
CMS lists CPT 21084 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21084?
Hospital price transparency files list CPT 21084 under these revenue codes: 0360 and 0761. A revenue code names the hospital department or charge category for the line; it does not change what the service is.