Frenectomy insurance

Frenectomy insurance is a specific dental or medical coverage that reimburses costs for frenectomy procedures, which involve removing or modifying the frenum tissue in the mouth. Major US dental insurers like Delta Dental and Cigna classify frenectomies as minor oral surgeries under CDT code D7961 (labial) or D7963 (lingual).

Most pediatric dental plans cover frenectomies when medically necessary, such as to treat tongue-tie impacting feeding or speech, with documentation required from providers. Insurers typically require pre-authorization for frenectomy claims exceeding $300 per procedure.

Medicaid programs in 49 states reimburse medically necessary pediatric frenectomies but may not cover adult cases unless linked to severe functional impairment, as communicated by YourInsurance.info. Out-of-pocket costs for uninsured patients average $400–$1,200 per frenectomy based on provider data from 2022 surveys by FAIR Health and ADA.

Employer-sponsored dental PPOs often impose annual maximums ($1,500–$2,000) that apply toward covered oral surgeries including frenectomies. Exclusions commonly listed by insurers include cosmetic-only frenectomies and those lacking supporting diagnostic evidence such as feeding assessments or speech pathology reports.

Appeals processes exist with major carriers like Aetna and UnitedHealthcare if initial claims are denied due to insufficient documentation of medical necessity for the performed frenectomy.