For Dates of Service Before January 1, 2021

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:

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 Code for Frenulectomy

Providers are required to indicate frenulectomy procedures using CDT code D7960 ("Frenulectomy – also known as frenectomy or frenotomy – separate procedure not incidental to another procedure").

The following billing rules apply to the coverage of frenulectomy procedures when billed under CDT code D7960:

Allowable Procedure Codes for Oral Surgeons

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

  • 40806 (Incision of labial frenum [frenotomy])
  • 40819 (Excision of frenum, labial or buccal [frenumectomy, frenulectomy, frenectomy])
  • 41010 (Incision of lingual frenum [frenotomy])
  • 41115 (Excision of lingual frenum [frenectomy])