Covered and Noncovered Services : Oral and Maxillofacial Surgery

Frenulectomy Procedures

Frenulectomy procedures involve the surgical removal or release of mucosal and muscle elements of a frenum associated with a pathological condition or interference with proper oral development or treatment.

ForwardHealth covers frenulectomy procedures without PA.

Members must meet one of the following criteria:

• The member's frenum creates a central incisor diastema.
• The member's frenum creates ankyloglossia.
• The member's frenum creates periodontal defects.
• The member's frenum requires removal to complete orthodontic services.
• The member's frenum interferes with denture stabilization, due to its high attachment on the ridge.

Note: An image of the obstructed frenum is not required to be submitted with claims, but must be available in the medical or dental record. A dentist statement regarding the medical/dental need for the treatment is required to be available upon request.

Allowable Procedure Codes for Frenulectomy

Providers are required to indicate frenulectomy procedures using one of the following CDT codes as applicable:

• D7961 (Buccal/labial frenectomy [frenulectomy])
• D7962 (Lingual frenectomy [frenulectomy])

The following billing rules apply to the coverage of frenulectomy procedures when billed under CDT codes D7961 or D7962:

• Covered areas of the oral cavity for frenulectomy procedures are 01 (maxillary arch) and 02 (mandibular arch). The area of the oral cavity is required to be indicated on the claim.
• Up to two units of service per area of the oral cavity are allowed per DOS. A total of four units are allowed per DOS.
• CDT codes D7961 and D7962 are defined as separate procedures, meaning that CDT codes D7961 and D7962 should not be separately billed when the frenulectomy is rendered in conjunction with any other surgical procedure in the same surgical area, by the same provider.

Allowable Procedure Codes for Oral Surgeons

Oral surgeons are required to indicate either CDT code D7960 or the following appropriate CPT codes: