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11.03.05e, Frenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)
Effective date
Not stated in the notice
Identified
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 11.03.05e on 03/04/2026 to reaffirm coverage of lingual frenectomy, frenotomy, or frenoplasty for ankyloglossia when medically necessary (difficulty feeding, chewing, swallowing, or speech impairment). The policy clarifies that labial and buccal frenum procedures remain dental exclusions. No substantive coverage changes were made; this is a routine policy reaffirmation.
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What to do
Action · 4 steps
01No immediate action required.
02Billing team should verify that current billing system configuration aligns with policy: CPT codes 41010, 41115, and 41520 (lingual frenum procedures) are processed as covered medical procedures when diagnosis Q38.1 is reported; HCPCS codes D7961 and D7962 are configured as benefit exclusions.
03Ensure claims documentation includes medical necessity (feeding difficulty, chewing impairment, swallowing difficulty, or speech impairment).
04No workflow changes are necessary as this is a reaffirmation of the continuing position.
Codes mentioned
4101041115415204080640819D7961D7962D7963Q38.1
Original notice
11.03.05e, Frenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)
medpolicy.ibx.com · Always check the source before changing claims.