Policy 7.01.21 sets which dental and oral services are eligible under medical or surgical contracts, with a current effective date of May 21, 2026. Oral surgical procedures, including dental extractions, periodontal treatment, and biopsies for cysts or tissue of dental origin, are ineligible under the medical portion of a subscriber contract unless otherwise stated, and X-rays including cone beam imaging for implant placement are ineligible under the medical benefit unless otherwise stated. Frenectomy (CPT 41115), frenotomy (CPT 41010) and frenoplasty (CPT 41520) of the lingual frenum are covered only for congenital ankyloglossia that restricts tongue movement and causes newborn feeding problems or speech articulation problems in children, and are considered not medically necessary when performed prophylactically to promote speech development.
Get alerts when payers change rules like this one
We check Excellus BlueCross BlueShield and other payers every day and email you when a change matches your specialty and state.
01Billing team: Frenectomy (CPT 41115), frenotomy (CPT 41010) and frenoplasty (CPT 41520) are covered under the medical contract only when congenital ankyloglossia restricts tongue movement and leads to newborn feeding problems or speech articulation problems in children.
02Prophylactic use to promote speech development in children or adults is considered not medically necessary.
03Tooth-related cysts are ineligible as a medical or surgical benefit.
04Biopsies that reveal only a dental condition make later care of that condition ineligible under medical or surgical contracts unless otherwise stated.
05Services for accidental injury to sound, natural teeth are eligible when rendered within 12 months of the injury, provided the tooth has no restorative treatment and no disease before the injury, and the services fall within a benefit category, are medically necessary under Corporate Medical Policy 11.01.15, and are rendered within 12 months of the injury.
Codes mentioned
410104111541520Q38.1
Original notice
Dental and Oral Care under Medical Plans 7.01.21
excellusbcbs.com · Always check the source before changing claims.
Summaries are AI-assisted. Always confirm against the original payer notice.
What is PolicyChanges
One workspace for payer rules, prior auth, coding and compliance
Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.