Dental and Medical Coverage for Frenectomy

Some babies and children have ankyloglossia, also known as tongue-tie. According to the Mayo Clinic, it is “a condition present at birth that restricts the tongue’s range of motion.” Essentially, a thick band of tissue known as the lingual frenectum attaches the bottom of the tongue to the mouth.  For some children, as they grow up, this resolves on its own while others may require medical or dental intervention.  They may need a treatment called a frenectomy (which can also be called frenotomy, frenulectomy, and frenulotomy) to correct this. Parents who have children with ankyloglossia can utilize their dental and medical coverage for frenectomy.  

Why should children have a frenectomy?

Children with ankyloglossia should get frenectomies for a variety of reasons. For instance, mothers may find breastfeeding their babies difficult because because their babies cannot easily latch on and feed properly.  Ankyloglossia may also affect how people talk when they grow up. For instance, they may have trouble saying such letters as d, l, n, r, s, t, th, and z. Tongue-tie also hinders people from cleaning their mouths efficiently because they cannot widely move their tongues to remove any food particles stuck in their teeth. Other problems related to ankyloglossia include difficulty wearing dentures, swallowing issues, and more. A frenectomy can treat ankyloglossia to resolve and prevent these issues in the future.

Insurance coverage for a frenectomy

Parents can utilize their dental or medical coverage for this procedure. Dental providers can bill dental insurance plans the codes for a comprehensive oral evaluation and frenectomy so that the patient’s parents can receive coverage for a frenectomy. The providers may have to distinguish between upper and lower arches for the dental insurance company.

They can also bill frenectomy to medical insurance companies because the companies view the procedure as medically necessary to address ankyloglossia and symptoms associated with it, such as difficulty breast feeding or speech impairment.” Dental providers may be able to ensure coverage for the patient’s parents by billing medical procedures, such as “Incision of lingual frenum (frenotomy),” “Excision of lingual frenum (frenectomy),” “Incision of labial frenum (frenotomy),” or “Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy),” when the diagnosis is ankyloglossia. However, if ankyloglossia does not apply, the medical insurance may not cover the frenectomy because it would be viewed as dental treatment instead of medical treatment. 

Ankyloglossia can cause many problems for children but a frenectomy, which can be covered by dental and medical insurance, may help  treat their condition. If you need assistance with billing frenectomies, or any other dental procedures, consider partnering with eAssist. Our Sucess Consultants are dental billing experts and will correctly bill any treatment you provide. To learn more, schedule a free consultation here.