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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 confirming continued coverage for lingual frenectomy, frenotomy, or frenoplasty when medically necessary for ankyloglossia (tongue-tie). The policy maintains that labial and buccal frenum procedures remain dental benefit exclusions. No substantive coverage changes were made; this is a routine policy reaffirmation.
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What to do
Action · 5 steps
01No immediate action required.
02This is a routine policy reaffirmation with no substantive changes to coverage or billing requirements.
03Billing team should verify that current system configuration correctly identifies CPT codes 41010, 41115, and 41520 as covered medical procedures and CPT codes 40806 and 40819 as non-covered dental exclusions.
04Ensure diagnosis code Q38.1 (Ankyloglossia) is required to support medical necessity for lingual frenum procedures.
05Documentation of functional impairment (difficulty feeding, chewing, swallowing, or speech) must be present in medical records for all claims.
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.