Lingual frenulum shortening is a condition known as Ankyloglossia, or “tongue tie.” Providers perform frenectomy or frenotomy as a kind of ankyloglossia treatment. (Madeline Goosmann,Claudia I. Cabrera Aviles,Jay Shah, 2022) When parents of young children detect their child has a “tongue-tie,” they frequently go to their dentist for guidance and assistance. (Ari Kupietzky,Eyal Botzer, 2004) In some places, lactation specialists can recommend that dentists treat Ankyloglossia (AG), which they have determined to be the main reason for the infant’s feeding issues. (Ari Kupietzky,Eyal Botzer, 2004) According to research, 69% of lactation consultants said that Ankyloglossia generally results in feeding issues. (Anna H Messner, M.Lauren Lalakea, 2000) It may also result in tooth decay.
Additionally, growing up with Ankyloglossia may also affect a person’s speech. (Burkhart, 2013) The research found that consonants like “t,” “d,” “l,” and “n” can all be severely affected by tongue-tie. (M.Varadan, A.Chopra, A.D.Sanghavi, K.Sivaraman, K.Gupta, 2019) Parents of children with Ankyloglossia may get a frenectomy through their dental and medical insurance. In order to improve mobility, the frenum, a band of fibrous tissue behind the tongue or top lip, is released during a frenectomy treatment. In research, mothers gave their opinion on frenectomy experience by these words: (Nor Asilah Harun, Noor Arisa, Mohamad Rashidi, Nur Fadzilah, Md Teni, Yunita Dewi Ardini, Nurjasmine Aida Jamani, 2022)
- Easy and simple
- Minimal bleeding
Furthermore, mothers told about the outcomes and advantages of frenectomy treatment in these words: (Nor Asilah Harun, Noor Arisa, Mohamad Rashidi, Nur Fadzilah, Md Teni, Yunita Dewi Ardini, Nurjasmine Aida Jamani, 2022)
- Speech, eating, and breastfeeding improvement. Research shows researchers discovered that lingual frenectomy increased speaking by 89%.(R. Baxter, R. Merkel-Walsh, N.R. Rendell, A. Lashley, B. Stark Baxter, 2020)
- Increase in weight.
Financial considerations are a concern and are among the primary aspects people consider while selecting whether or not to have a procedure done. There are numerous ways to assist pay for procedural expenses, with a dental insurance plan being the most popular. People have questions regarding insurance; therefore, In this article, we will discuss medical insurance FAQ’s for Frenectomy.
Some FAQ's for medical insurance for frenectomy
Does insurance cover frenectomy?
For kids, Ankyloglossia can lead to a variety of issues. Research finds that Ankyloglossia affects 1.7% of newborns. (A. S. Anku, B. Pradeep, N. Satyanarayana, K. Ruchi, K.Varun, K. Neha, P. Sunitha, N.Reddy, 2010) In order to correct their issue, they can have a frenectomy, which may be covered by medical and dental insurance.
How much does a frenectomy cost?
Infant ankyloglossia is most frequently treated with a standard frenotomy. A few millimeters are incised through the lingual frenulum to perform a frenotomy. (Lauren M. Segal, Randolph Stephenson, Martin Dawes, Perle Feldman, 2007) The typical cost of a frenulectomy/frenectomy/frenotomy is from $500 to $1,500. An analysis of frenectomies performed at The Children’s Hospital of Philadelphia in 2014 estimated the surgery cost to be $850 without considering additional anesthesia or hospital costs. (De’Shon Toner, Teresa Giordano, Steven D Handler, 2014) However, the price can differ significantly depending on the clinic doing the frenectomy, whether anesthesia is needed, if it requires more than one visit, and if so, what sort.
A frenectomy can cost more overall, depending on extra costs, including the first consultation to evaluate whether a frenectomy is required. Any further treatments that may be needed after your frenectomy, though they are seldom required, can also affect the overall cost of your procedure. Also, post-operative care fees, like antibiotic therapy, may be incurred. Although it is not frequently required, it is crucial to know that this extra expense can matter.
Furthermore, even though the treatment is comparatively painless, painkillers could be required to control suffering during the healing process. Before arranging the surgery, discuss your projected expenditures with your periodontist if you are worried about the cost of the treatment.
Is lingual frenectomy covered by insurance for adults?
Frenectomy or frenotomy of the lingual frenulum for Ankyloglossia is considered medically essential and thus covered for any of the symptoms listed: (Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie), 2017)
- Feeding/eating difficulties
- Chewing difficulties (mastication)
- Swallowing difficulties
- Speech impediment or articulation difficulties
Except for Ankyloglossia, any procedures involving the lingual frenum are always categorized as dental and not as medical. (Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie), 2017)
Does insurance cover tongue-tie surgery for babies?
Dr. Ghaheri, an ENT surgeon, says that the treatment for tongue tie release will be covered by most commercial medical insurance. Many will pay for the treatment by itself if it is done by an MD, NP, DO, or PA-C. If the dentist’s practice understands how to bill medical insurance, specific insurances will also pay for a dentist to do the treatment. (Ghaheri, 2016)
Does Medicare cover a frenectomy?
No matter how complicated or challenging the operation, Medicare will not pay for it if an excluded service is the crucial part. No matter how complex or challenging the process is, it is not covered by Medicare if an excluded service is the main component. For instance, when either an alveoplasty or a frenectomy is carried out in conjunction with an excluded service, such as the mouth preparation for dentures, they are not covered. (Dental Services – Medicare Advantage Policy Guideline, 2021)
Will my dental insurance help cover the cost of a frenectomy?
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.
Dental and medical billing guidelines for frenectomies
According to data from the American Academy of Pediatric Dentistry, the frequency of frenectomy treatments has increased by 90% in recent years. Dental practices are expected to embrace the modifications and assure accuracy in their claims because the ADA (American Dental Association) routinely modifies the CDT (Current Dental Terminology) codes. Documenting dental procedures thoroughly and accurately can be made easier with the aid of a dental billing company.
For the treatment of Ankyloglossia, the lingual frenum is removed or cut using the CPT codes listed below: (Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie), 2017)
The following CPT codes are regarded as benefit exclusions:
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