Policy No: 102
Originally Created: 03/01/2014
Last Reviewed: 03/01/2019
Last Revised: 02/01/2015
This policy does apply to professionals and facilities.
Current Procedural Terminology (CPT®) 40806 – Incision of labial frenum (frenotomy)
This procedure is performed to free the lip and/or cheek and allow greater range of motion. The labial frenum is the connecting fold of mucous membrane that joins the lip and/or cheek to the alveolar structures (e.g., mucosa, gums, gingiva, and/or the underlying periosteum).
CPT 41010 – Incision of lingual frenum (frenotomy)
This procedure is performed to free the tongue and allow greater range of motion. The lingual frenum is the connecting fold under the tongue attaching it to the floor of the mouth.
Incision of lingual frenum (CPT 41010) is eligible for reimbursement under the member's medical benefit if the condition being diagnosed and treated is one which is non-contiguous to the teeth and/or gums.
Incision of labial frenum (CPT 40806) is considered a dental procedure and allowable under the dental benefit. The procedure may be eligible for reimbursement under the member's medical benefit on infants less than 12 months of age with feeding problems or other functional issues.
Frenotomy services are typically performed in the office with or without local anesthesia. General anesthesia services and related facility services, when medically necessary, are processed under the member's medical benefit.
Anesthesia services are subject to the anesthesia reimbursement policy and must be performed by an independent anesthetist/anesthesiologist. Anesthesia will not be reimbursed to the physician performing the procedure.
Frenulectomy - Dental Policy Manual