26 Mar Dental and Medical Coverage for Frenectomy
Some babies and children have ankyloglossia, which refers to tongue-tie, “a condition that restricts the tongue’s range of motion. With tongue-tie, short, thick or tight band of tissue (lingual frenulum) holds the bottom of the tongue’s tip to the floor of the mouth” (“Frenotomy Frenulotomy and Frenectomy”). For some children, when they grow up, “the lingual frenulum loosens over time and tongue-tie resolves on its own. In other cases, tongue-tie persists without causing problems” (“Frenotomy Frenulotomy and Frenectomy”). Other children may need treatment called frenectomy, which can also be called frenotomy, frenulectomy, and frenulotomy, in order to “remove the frenulum…” (“Frenotomy Frenulotomy and Frenectomy”). Parents that have children with ankyloglossia can utilize their dental and medical coverage for frenectomy.
Children with ankyloglossia should get frenectomies for a variety of reasons. For instance, mothers may find breastfeeding their babies difficult because due to the condition, their babies cannot easily “‘[latch] onto the breast, [express] milk, and [make] a seal to nurse correctly and without excessively ingesting air’” (Burkhart 2013). Ankyloglossia may also affect how people talk when they grow up (Burkhart 2013). For instance, they may have “[t]rouble saying d, l, n, r, s, t, th, and z sounds” (“What Is Tongue-Tie in Babies?” 2018, 2). Tongue-tie also hinders people from cleaning their own mouths efficiently because they cannot widely move their tongue to remove any “food particles” stuck in their teeth (Burkhart 2013). Other problems related to ankyloglossia include “difficulty wearing dentures,” “swallowing disorders,” etc. (Burkhart 2013). A frenectomy can treat ankyloglossia in order to resolve and prevent these issues in the future.
Parents can utilize their dental or medical coverage for this procedure. Dental providers can bill dental insurance plans the codes for “Comprehensive Oral Evaluation” and frenectomy so that the patient’s parents can receive coverage for a frenectomy (“Insurance & Fees”). The providers may have to distinguish between upper and lower arches for the insurance company (“Insurance & Fees”). They can also bill frenectomy to medical insurance companies because the companies view the procedure as “medical necessary” to address ankyloglossia and symptoms associated with it, 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). Dental providers may be able to ensure coverage for the patient’s parents by billing procedures, such as “Incision of lingual frenum (frenotomy),” “Excision of lingual frenum (frenectomy),” “Incision of labial frenum (frenotomy),” “Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy),” when the diagnosis is ankyloglossia (Snow 2018). However, if patients need treatments for “the lingual frenum (other than for ankyloglossia), the labial frenum, and the buccal frenum,” medical insurance may not cover those treatments because it would view them as dental treatments instead of medical treatments (“Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie)” 2017).
Ankyloglossia can cause many problems for children. They can go through frenectomy, which can be covered by dental and medical insurance, in order to treat their condition.