AmeriHealth 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:
The following CPT codes are considered a benefit exclusion:
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.