Ankyloglossia - also known as tongue-tie, is a condition that impairs tongue movement due to a restrictive lingual frenulum.
Current Procedural Terminology (CPT®) 40806 - Incision of labial frenum (frenotomy)
This procedure is performed to free the lip and/or cheek and allow greater range of motion. The labial frenum is the connecting fold of mucous membrane that joins the lip and/or cheek to the alveolar structures (e.g., mucosa, gums, gingiva, and/or the underlying periosteum).
CPT 41010 – Incision of lingual frenum (frenotomy)
This procedure is performed to free the tongue and allow greater range of motion. The lingual frenum is the connecting fold under the tongue attaching it to the floor of the mouth.
Note: This policy is not effective until 12/1/2024. To view the current policy, click here.
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.
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Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.