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Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie)

April 14, 2017

Independence has created a policy to communicate the coverage position on frenectomy or frenotomy of the lingual frenulum for ankyloglossia. Medical Policy #11.03.05c: Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie) was posted as a Notification on April 6, 2017, and goes into effect July 5, 2017.

Frenectomy or frenotomy of the lingual frenulum for ankyloglossia is considered medically necessary and, therefore, covered for any of the following symptoms:

  • difficulty feeding/eating;
  • difficulty chewing (mastication);
  • difficulty swallowing;
  • speech impairment or difficulty with articulation.

Procedures associated with the lingual frenum (other than for ankyloglossia), the labial frenum, and the buccal frenum are always considered dental procedures and never considered medical procedures. Therefore, these procedures are considered benefit contract exclusions.

Procedure codes

The following CPT® codes are used to represent frenectomy or frenotomy of the lingual frenum for ankyloglossia:

  • 41010
  • 41115
  • 41520
The following CPT codes are considered a benefit exclusion:
  • 40806
  • 40819
  • D7960
  • D7963

More information

To view the Notification for this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial under Active Notifications.

CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.


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