$1,312.20
Choose 21084 for custom preparation of a speech aid prosthesis, commonly using a speech bulb. Choose 21083 when the appliance is a palatal lift that raises the soft palate.
On this page
CMS RVU26D · Effective 2026-10-01
21084 Speech aid prosthesis Medicare reimbursement rates in Nebraska
Reported for an impression and custom preparation of a speech aid prosthesis that helps address velopharyngeal insufficiency affecting speech. Compare 21084 office and facility rates across CMS payment localities in Nebraska.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 21084 in Nebraska?
Nebraska has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$1497.44
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
Facility setting
$986.30
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Maxillofacial prosthetics
About 21084: Custom speech aid prosthesis preparation
Reported for an impression and custom preparation of a speech aid prosthesis that helps address velopharyngeal insufficiency affecting speech.
A maxillofacial prosthodontist or other qualified dental or medical professional takes an impression and custom-prepares an intraoral speech aid prosthesis. A common design uses a speech bulb extending toward the nasopharynx to help improve closure when the soft palate cannot adequately separate the oral and nasal passages. The service may be provided in an outpatient clinic or hospital setting for congenital or acquired velopharyngeal dysfunction.
Select this code when the documented service is custom preparation of a speech aid prosthesis, rather than a palatal lift, palatal augmentation prosthesis, or obturator. The record should identify the speech-related functional problem, relevant anatomy and findings, and the impression and custom preparation performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21084
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU21.92 · 45%
- Practice expense (office) RVU23.80 · 49%
- Malpractice RVU2.50 · 5%
32
Medicare services in 2024 · #5610 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
21084 compared with similar codes
Office rates for Nebraska, from the same CMS release.
$1,391.56
Code 21082 is for a palatal augmentation prosthesis. It is selected for its palatal contour and oral-function purpose, not for a speech aid prosthesis.
$1,606.49
Code 21080 describes definitive obturator preparation for a maxillary defect. Use 21084 when the prepared appliance is a speech aid prosthesis rather than an obturator.
$1,414.09
Code 21079 is for interim obturator preparation. It is not the speech aid prosthesis service represented by 21084.
Compare 21084 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Nebraska →
Office / nonfacility
$1497.44
Facility
$986.30
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21084 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
1,868
- Code
- 21084
- Physician work
- 21.92
- Practice expense
- 23.80
- Malpractice
- 2.50
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.92 | × 1.000 | 21.9200 |
| Practice expense | 23.80 | × 0.923 | 21.9674 |
| Malpractice | 2.50 | × 0.378 | 0.9450 |
| Total RVUs | 44.8324 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Nebraska$1497.44
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.92 | 1 |
| Practice expense | 23.8 | 0.923 |
| Malpractice | 2.5 | 0.378 |
(21.92 × 1 + 23.8 × 0.923 + 2.5 × 0.378) × $33.4009 = $1497.44
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.92 | 1 |
| Practice expense | 7.22 | 0.923 |
| Malpractice | 2.5 | 0.378 |
(21.92 × 1 + 7.22 × 0.923 + 2.5 × 0.378) × $33.4009 = $986.30
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21084 billing questions
How is this different from a palatal lift prosthesis?
A speech aid prosthesis commonly uses a bulb to help close the velopharyngeal gap. A palatal lift raises a mobile but weak soft palate; select based on the prosthesis designed and the patient's functional problem.
When would an obturator code be more appropriate?
Use an obturator code when the prosthesis is designed to close an oral or palatal defect, such as a defect after maxillary surgery. Code 21084 describes custom preparation of a speech aid prosthesis for a speech-related functional problem.
What should the documentation establish?
Document the speech-related dysfunction, pertinent palate and velopharyngeal findings, the impression taken, and the custom prosthesis preparation performed.
How does the 90-day global period affect related care?
The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%. Assistant-at-surgery payment requires documentation of medical necessity.
Can modifier 50 or co-surgeon billing be used?
The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,86521081,,Impres&prep mndbl res prosth,A,,22.28,22.71,,6.95,,2.68,47.67,31.91,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86621082,,Impres&prep paltl aug prosth,A,,20.32,22.14,,7.02,,2.40,44.86,29.74,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86721083,,Impres&prep paltl lft prosth,A,,18.79,21.33,,6.49,,2.14,42.26,27.42,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86821084,,Impres&prep sp aid prosth,A,,21.92,23.80,,7.22,,2.50,48.22,31.64,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86921085,,Impres&prep oral surg splint,A,,8.77,11.42,,3.03,,1.07,21.26,12.87,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87021086,,Impres&prep auricular prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87121087,,Impres&prep nasal prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068