Frenectomy or Frenotomy for Ankyloglossia

Frenectomy/frenotomy/frenuloplasty (CPT 40806, 40819, 41010, 41115, 41520; HCPCS D7960‑D7962) is covered for ankyloglossia (Q38.1) when there are documented newborn feeding problems (P92.01‑P92.9) or childhood articulation deficits, while prophylactic procedures to promote speech and lingual frenuloplasty combined with myofunctional therapy for dental clenching, mouth breathing, myofascial tension or snoring (and associated diagnoses F45.8, G47.63, M79.18, R06.5, R06.83) are considered experimental/not covered. Coverage is contingent on meeting the plan’s documented selection criteria for medical necessity; myofunctional therapy for these indications is not covered.

"CPT codes 40806, 40819, 41010, 41115, 41520 are covered if selection criteria are met."

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