Frenectomy procedures can be billed to both dental and medical insurance, but only when coded correctly and supported by the right documentation. Here’s what dental teams need to know to bill frenectomies accurately and capture reimbursement from both sources.
What Is a Frenectomy?
A frenectomy is the surgical removal or release of a frenum — a band of soft tissue that connects the lips, cheeks, or tongue to the jawbone or gum tissue. The procedure may also be referred to as a frenotomy, frenulectomy, or frenulotomy depending on the technique used.
Frenectomies are most commonly performed to treat ankyloglossia (tongue-tie), a condition present at birth in which a thick band of tissue restricts the tongue’s range of motion. They may also be performed to address a labial frenum that causes a gap between the front teeth or contributes to gum recession.
Why Is a Frenectomy Performed?
Frenectomies are performed for a variety of clinical reasons, including:
- Difficulty breastfeeding in newborns due to poor latch caused by tongue-tie
- Speech impairment — ankyloglossia can affect the ability to produce certain sounds
- Difficulty cleaning the mouth effectively due to restricted tongue movement
- Gap between the upper front teeth caused by a prominent labial frenum
- Gum recession associated with frenum attachment
- Difficulty wearing dentures
- Swallowing issues
CDT Codes for Frenectomy
The following CDT codes are used to report frenectomy procedures. Verify codes and descriptions against the current CDT code set before submitting claims.
| CDT Code | Procedure Description | Notes |
|---|---|---|
| D7961 | Buccal/labial frenectomy (frenulectomy) | Reports excision of labial or buccal frenum |
| D7962 | Lingual frenectomy (frenulectomy) | Reports excision of lingual frenum — commonly used for tongue-tie |
| D7963 | Frenuloplasty | Reports surgical reshaping of the frenum — distinct from frenectomy |
Frenectomy CDT to CPT Cross-Code Reference
When billing a frenectomy to medical insurance, CPT codes are required in place of CDT codes. The following cross-codes may apply depending on the procedure performed. Always verify with the patient’s medical carrier before submitting.
| Procedure | CDT Code | CPT Cross-Code |
|---|---|---|
| Excision of lingual frenum (frenectomy) | D7962 | 21080 |
| Excision of frenum, labial or buccal (frenectomy) | D7961 | 40819 |
| Frenuloplasty | D7963 | 41520 |
Cross-code mappings vary by payor. Always verify with the patient’s medical carrier before submission.
Dental Insurance Coverage for Frenectomy
Dental insurance plans may cover frenectomy procedures. When billing dental insurance, providers should:
- Report the appropriate CDT code for the procedure performed
- Distinguish between the upper and lower arch when required by the payor
- Submit supporting documentation including clinical notes and, where applicable, diagnostic images
- Verify whether the plan has any age limits, frequency limits, or pre-authorization requirements for the procedure
Medical Insurance Coverage for Frenectomy
Frenectomy procedures may also be billed to medical insurance when the procedure is medically necessary. Medical payors typically consider frenectomy medically necessary when the diagnosis is ankyloglossia, and the procedure is performed to address symptoms such as difficulty breastfeeding or speech impairment.
If ankyloglossia does not apply as the diagnosis, medical insurance is unlikely to cover the frenectomy — it would be viewed as dental treatment rather than medical treatment.
When billing medical insurance for a frenectomy:
- Submit the claim on the CMS-1500 form — not the ADA Dental Claim Form
- Use CPT codes in place of CDT codes
- Include the appropriate ICD-10 diagnosis code for ankyloglossia as the primary diagnosis, followed by any supporting diagnosis codes — such as those related to poor latch or failure to thrive — assigned by the pediatrician or lactation consultant
- Include a narrative establishing medical necessity
- Verify whether pre-authorization is required before performing the procedure
For a full overview of dental medical billing, see our guide: Dental Medical Billing: A Complete Guide for Dental Practices.
Documentation Requirements
Strong documentation is essential for frenectomy claims — particularly when billing medical insurance. Clinical notes should include:
- The diagnosis (e.g., ankyloglossia) and how it was identified
- The patient’s symptoms and how they affect daily function (feeding, speech, oral hygiene)
- The procedure performed and which arch was treated
- Medical necessity — why the procedure was required from a clinical standpoint
- For newborns: documentation of breastfeeding difficulty and its impact
Frequently Asked Questions
Yes — frenectomy procedures may be billed to both dental and medical insurance. Dental insurance is billed using CDT codes on the ADA Dental Claim Form. Medical insurance is billed using CPT codes on the CMS-1500 form, with an ICD-10 diagnosis code establishing medical necessity. When billing both, coordination of benefits rules must be followed, and requirements can vary by state — always confirm the rules in your state before billing both carriers. Verify coverage with both payors before the procedure.
D7961 reports the excision of a labial or buccal frenum and is used for procedures involving the lip or cheek. D7962 reports the excision of a lingual frenum and is the code most commonly used for tongue-tie (ankyloglossia) procedures. D7963 reports a frenuloplasty — the surgical reshaping of the frenum — which is a distinct procedure from a frenectomy. The specific procedure performed determines which code applies.
Pre-authorization requirements vary by plan. Always confirm whether pre-authorization is required when verifying the patient’s benefits — for both dental and medical coverage. If pre-authorization is required and not obtained before the procedure, the claim will be denied.
A frenotomy is an incision of the frenum to release the restriction, while a frenectomy is the excision (removal) of the frenum. Both procedures may be referred to by several names — frenulectomy and frenulotomy are also used. The specific procedure performed determines which CDT and CPT codes apply.
Need Help Billing Frenectomies?
Frenectomy billing involves navigating both dental and medical insurance — each with its own coding requirements, documentation standards, and pre-authorization rules. If your team is struggling with frenectomy claims or dental medical billing, consider partnering with eAssist. Our Success Consultants are familiar with cross-coding and will work to get your claims billed correctly. To learn more, schedule a free consultation.
Disclaimer: Insurance administration and dental billing recommendations, as well as interpretations of the CDT codes, represent the opinions of our experts. For the latest CDT codes and official interpretations, contact the American Dental Association or visit ADA.org. You are responsible for your own use of the CDT Codes, insurance administration, and dental billing.
