Frenectomy or Frenotomy for Ankyloglossia (CPB 0116, reviewed 2026-03-26)
Aetna Clinical Policy Bulletin 0116 considers lingual or labial frenectomy, frenotomy, or frenuloplasty medically necessary for ankyloglossia when newborn feeding difficulties or childhood articulation problems exist. Atmospheric plasma lingual frenectomy, lingual frenuloplasty with myofunctional therapy for dental clenching, mouth breathing, myofascial tension, and snoring, oro-myofunctional therapy following frenectomy, and prophylactic frenectomy, frenotomy or frenuloplasty to promote speech development are considered experimental, investigational, or unproven. The policy was last reviewed 03/26/2026.