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See a sample rate comparisonCPT 21084 Fee Schedule
Last Verified: September 2026
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.
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 | 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 |
| Medicaid Fee Schedule | View Medicaid rates for 21084 |
National average reimbursement for CPT 21084 by major payers:
$1,957.75
$2,246.24
$2,187.55
$2,167.82
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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 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 | 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 | High | 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 | High | 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 | Moderate | 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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