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ICD-10-CM P92.5 — Neonatal difficulty in feeding at breast | No Prior Auth

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`P92.5` — Neonatal difficulty in feeding at breast

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Key Coverage Criteria

A lingual frenotomy is consideredmedically necessaryfor the treatment of ankyloglossia-related feeding difficulties whenallthe following criteria (1-4) are met:
Infant is experiencing feeding difficulties (for example, poor latch, lactating parent nipple pain);and
Severity of ankyloglossia confirmed by either of the following:Score of 5 or below on the Tongue-tie and Breastfed Babies (TABBY) assessment tool;orScore of 5 or below on the Bristol Tongue Assessment Tool (BTAT);and
Score of 5 or below on the Tongue-tie and Breastfed Babies (TABBY) assessment tool;or
Score of 5 or below on the Bristol Tongue Assessment Tool (BTAT);and
Feeding difficulty persists despite conservative management approaches, which may include the following:Lactation consultation;orSpeech-language pathology consultation;and

1 Active Policy

ANTHEM-CG-SURG-122 — CG-SURG-122 Lingual Frenotomy for Ankyloglossia-Related Feeding Difficulties

Related Codes

41010(1 policies)F3448(1 policies)Q38.1(1 policies)R63.30(1 policies)R63.39(1 policies)

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