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.
FAQs
Does insurance cover Frenectomies for kids? Yes! Many dental and medical insurance plans cover frenectomies since they are considered necessary for treating conditions like Ankyloglossia, which can cause significant problems for children.
Is frenectomy considered dental or medical? ›
Frenectomy – A Covered Dental Procedure
It is required to correct congenital malformation( Ankyloglossia)
Is a frenectomy covered by medical insurance? ›
Insurance coverage for this procedure should be processed from your dental and/or medical insurance policy. If this procedure is covered under your dental or medical insurance plan, you (the subscriber) will need to submit the claim and pursue reimbursem*nt directly from the insurer.
Can a general dentist do a frenectomy? ›
Most oral frenectomies are simple procedures that can be handled by your doctor or dentist, but sometimes it's performed by an oral surgeon or ENT (ear, nose, and throat) specialist. Regardless of who performs the frenectomy, the process is essentially the same and takes about fifteen minutes.
Is tongue-tie a medical or dental procedure? ›
Some insurance plans consider it a dental procedure, and some consider it a medical procedure. The location of the correction (tongue or lip) is also a factor. For example, some policies will consider a tongue tie a dental procedure, but a lip tie a medical procedure.
How do you get a frenectomy covered? ›
Most dental insurance policies cover a frenectomy surgery because they view it as a cosmetic procedure. A few insurance policies pay up to 50% of the cost of the procedure. You should contact your insurer to find out if your plan covers the procedure.
Does insurance cover tongue tie release? ›
This procedure is not typically covered under medical insurance; however, it is based on the type of plan that you have. If you think that your medical insurance will cover this procedure, and would like to seek reimbursem*nt from them, we are happy to provide any necessary documentation you may need to submit a claim.
How much does a frenectomy usually cost? ›
On average, a frenulectomy costs usually costs between $500 to $1,500; however, the cost will vary greatly depending on the clinic where the frenectomy is performed, whether the procedure can be performed in one visit, and whether sedation is used, and if so, what kind.
Why is a frenectomy so expensive? ›
The amount of tissue being removed, age of the patient, geographic market of the doctor performing the procedure, and method used in surgery can also impact overall cost. Laser surgery is typically more expensive as it requires a greater level of training and expertise than the traditional scalpel method.
Is frenectomy medically necessary? ›
Frenectomies are common procedures performed in pediatric dentistry, but they're only necessary if a child has a tongue or lip tie.
A tight frenum makes cleaning the teeth difficult. It can cause oral problems, including speech and eating difficulties, gaps between the front teeth, and speech difficulty. However, getting a frenectomy gives the lips free movement, improving your smile.
How much does a lingual frenectomy cost? ›
The costs for the full work-up exam and assessment is $125.00. The first procedure (lingual frenulectomy) is $400.00. If a second procedure site (labial frenulectomy) is needed to be performed is $175.00 additional.
What is the recovery time for a frenectomy? ›
▸ What's the recovery process and time? Full tissue healing occurs after six weeks. Most patients have described this as a sore throat feeling. Our patients have reported that the most discomfort is felt between days 2-5.
How painful is a frenectomy? ›
Not to worry, a labial frenectomy is a quick and pain-free procedure that is done in one visit. Two methods can be used including laser surgery and traditional surgery.
Does insurance cover tongue tie surgery for adults? ›
Is tongue-tie covered by insurance? Often, insurance providers and plans will cover the cost of a frenotomy or a frenuloplasty. If you're unsure whether your particular provider or plan would cover the cost of a procedure with us at Beyond Dental & Implant Center, you can give us a call so we can look into it for you.
At what age should a tongue tie be cut? ›
How is Lip/Tongue Tie Treated? A frenectomy is used to correct lip or tongue tie. It is recommended your child has the simple procedure before the age of 12 months to prevent the need for anesthesia or sedation; however, it can be performed when they are older as well.
What is a frenectomy considered? ›
A frenectomy is an oral surgery procedure that treats a lip-tie or tongue-tie. It may be used to increase your tongue's range of motion or help close a gap between two teeth.
What type of surgery is a frenectomy? ›
A frenectomy is a simple procedure designed to remove or loosen the tissue that connects your gums and lips to your teeth. The goal of the procedure is to improve the health and appearance of your smile.
What is the medical coding for frenectomy? ›
D7961 (Buccal/labial frenectomy [frenulectomy]) D7962 (Lingual frenectomy [frenulectomy])
What type of doctor performs a frenectomy? ›
Qualified practitioners include: Dentists: General dentists, pediatric dentists, and orthodontists may perform frenectomies, particularly those involving the labial frenulum. Periodontists: A periodontist like Dr. Scharf, is specifically trained in all areas of periodontal (gum) and oral tissues.
