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Does Insurance Cover Frenectomy? Exploring Your Options

Does insurance cover frenectomy? Learn about the different coverage options available by exploring this post today!

Ankyloglossia, often known as tongue-tie, is a disorder that limits the tongue’s range of motion in some infants and young children. According to “Frenotomy Frenulotomy and Frenectomy,” tongue-tie is a condition in which a short, thick, or tight band of tissue (lingual frenulum) ties the tip of the tongue’s base to the floor of the mouth. When kids get older, “the lingual frenulum loosens with time and tongue-tie resolves on its own,” according to several studies.

Other times tongue-tie doesn’t bother anyone (see “Frenotomy Frenulotomy and Frenectomy”) and goes on. Some kids might require a procedure termed a frenectomy, also known as a frenotomy, frenectomy, or frenotomy, to “remove the frenulum.” (See “Frenectomy, Frenulotomy, and Frenotomy”). Parents of children with ankyloglossia may get a frenectomy through their dental and medical insurance.

There are several reasons why frenectomies should be performed on ankyloglossia children. For example, women could find it challenging to breastfeed their infants because of the disease, which makes it difficult for the infants to “[latch] onto the breast, [express] milk, and [create] a seal to nurse appropriately and without unduly ingesting air” (Burkhart 2013). Ankyloglossia may impact a person’s speech patterns as they mature (Burkhart 2013). For example, they might struggle to pronounce the sounds “d, l, n, r, s, t, th, and z” (What Is Tongue-Tie in Babies? 2018, p. 2). Moreover, tongue ties prevent people from effectively cleaning their mouths since they cannot move their tongue broadly enough to remove any “food particles” that may be caught in their teeth (Burkhart 2013). Ankyloglossia can also cause issues with swallowing, wearing dentures, and other things (Burkhart 2013). Ankyloglossia can be treated with a frenectomy to address and avoid these problems in the future.

For this surgery, parents might use their dental or medical insurance. For the patient’s parents to acquire coverage for a frenectomy, dental professionals can charge dental insurance plans with the codes for “Comprehensive Oral Examination” and “Frenectomy” (“Insurance & Fees”). For the insurance company, the providers might need to distinguish between upper and lower arches (“Insurance & Fees”).

They may also submit claims for frenectomy to health insurance providers because these organizations consider the procedure to be “medically necessary” to treat ankyloglossia and its accompanying symptoms, such as “Neonatal difficulty in feeding at breast,” “speech impairment or difficulty with articulation,” etc. (Nierman 2018; “Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie)” 2017; Snow 2018). By billing procedures like “Incision of lingual frenum (frenotomy),” “Excision of lingual frenum (frenectomy),” “Incision of labial frenum (frenotomy),” and “Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy),” dental professionals may be able to ensure coverage for the patient’s parents (Snow 2018). Medical insurance might not pay for procedures needed to treat “the lingual frenum (other than for ankyloglossia), the labial frenum, and the buccal frenum” because they would be viewed as dental procedures rather than medical ones (“Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie)” 2017).

Ankyloglossia can cause several issues for children. Individuals can undergo a frenectomy to treat their issue, which may be covered by dental and medical insurance.

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