Policy Statement
Incision of lingual frenum (CPT 41010) is eligible for reimbursement under the member’s medical benefit, if the condition being diagnosed and treated is one which is non-contiguous to the teeth and/or gums.
Incision of labial frenum (CPT 40806) is considered a dental procedure and allowable under the dental benefit. The procedure may be eligible for reimbursement under the member’s medical benefit if related to feeding problems or other functional issues.
Prior to any surgical intervention, the diagnosis should be made by a qualified healthcare professional (pediatrician, family practitioner) other than the rendering provider. Physical examination must confirm one of the following:
- The presence of “tongue-tie” causing the inability to adequately breast or bottle feed due to ineffective latch
- Difficulty with speech due to the inability to manipulate the tongue
- Evidence of failure to thrive, weight loss or decreasing age-adjusted growth percentiles
Frenotomy services are typically performed in the office with or without local anesthesia. General anesthesia services and related facility services, when medically necessary, are processed under the member’s medical benefit.
Anesthesia services are subject to the anesthesia reimbursement policy and must be performed by an independent anesthetist/anesthesiologist. Anesthesia will not be reimbursed to the physician performing the procedure.
References
Cross References
- Ane 102 – Anesthesia Reimbursement and Services Reporting
