CommercialCoverageMedium impact
11.03.05e, Frenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)
Independence Blue Cross·Dentistry, Oral & Maxillofacial Surgery, Pediatrics·Medical Policy
Effective date
May 14, 2025
We identified it
Jun 19, 2026
Summary
This is a reissued policy (effective 05/14/2025) on frenectomy, frenotomy, or frenoplasty procedures for ankyloglossia (tongue-tie). Without access to the full policy text content, specific coverage criteria, billing code requirements, prior authorization mandates, or changes from the previous version cannot be determined. The medical billing team must review the complete policy document to identify coverage parameters, medical necessity requirements, and any billing workflow impacts.
Action Required
By 05/14/2025: Billing team must obtain and review the complete policy document at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=05&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-11-03-05e. Document any changes from the prior version of policy 11.03.05e, including: (1) covered CPT/HCPCS codes for frenectomy/frenotomy/frenoplasty procedures, (2) medical necessity criteria and documentation requirements, (3) prior authorization requirements, (4) age/clinical eligibility restrictions, (5) frequency limitations. Update billing system rules, encounter forms, and provider guidance accordingly. Communicate requirements to clinical staff, front desk, and billing personnel. Without this review, claims may be denied if submitted under outdated or incorrect criteria.