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Policy No:  67

Originally Created: 09/01/1997

Section: Miscellaneous

Last Reviewed:  01/01/2019

Last Revised:  01/01/2018

Approved: 01/01/2018

Effective:  01/01/2018



The use of special techniques to correct the anterior tongue position, also called tongue thrust, and its associated problems (i.e., open bite, protrusion of incisors and lisping).


Procedure is in accordance with generally accepted standards of dental practice.

Administrative guidelines

Process to contract benefits.

  • Appliances for habit breaking of tongue thrust - Process to the orthodontia benefit. Procedure codes D8210 & D8220
  • Appliances for speech therapy as a result of tongue thrust - Process to the medical benefit CPT code 21084


CDT - see above


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