How to Bill for Frenectomies — Dental and Medical Coding Simplified

We know clinical excellence must be matched with operational precision. Performing functional releases that support airway and sleep health is only part of the process—accurate billing and documentation ensure patients receive their benefits and your practice is reimbursed properly. Whether a release is billed to dental or medical insurance depends on the indication, anatomy, and documentation. 

 

When to Bill Dental Insurance 

Bill dental when the clinical rationale is primarily dental in nature (e.g., site-specific tissue tension affecting hygiene, diastema management, orthodontic stability/relapse prevention, or speech facilitation not linked to congenital malformation). 

CDT procedure codes (current since 2021): 

• D7961 — Buccal or labial frenectomy (frenulectomy)

• D7962 — Lingual frenectomy (frenulectomy)

Note: D7960 was retired in 2021; do not use it. Always submit claims using the current CDT version for dates of service on/after January 1 each year. 

Best practices for dental claims 

Include a complete, consistent packet: 

• Pre- and post-op photos or radiographs (as appropriate) 

• Periodontal charting if relevant 

• Clear clinical narrative describing functional limitations and expected benefit 

• Site specificity (labial, buccal, lingual; tooth/region if applicable) 

Sample dental narrative 

“Lingual frenectomy performed to increase tongue mobility and enable proper palatal rest posture. Expected functional benefits include improved chewing, swallowing, and speech articulation.” 

Coverage cautions 

• Many plans cover frenectomy once per lifetime per site. 

• If performed the same day as connective tissue or pedicle grafting, payers may treat the frenectomy as inclusive of the graft service (no separate payment). 

• Verify plan limitations and pre-authorization requirements before scheduling. 

 

Incision vs. Excision (and Why It Matters) 

• Frenotomy (Incision): A precise incision to release a tight frenum without removing it entirely. Often used for infants or mild restrictions. Think “release,” not removal. 

• Frenectomy (Excision): Removal of the frenum when tissue is short, dense, or fibrotic. Think “removal,” not release. 

Coding follows the procedure performed, not the instrument used. Using a soft-tissue laser (e.g., DEKA Laser) does not change the code selection. 

 

When to Bill Medical Insurance 

Bill medical when the condition is a functional impairment or congenital malformation (e.g., ankyloglossia) impacting feeding, swallowing, speech, or breathing. Pair your procedure code with diagnosis codes that establish medical necessity, and include a concise, clinically focused narrative (LMN). 

Common CPT codes 

• 41010 — Incision of lingual frenum (frenotomy) 

• 40806 — Incision of labial frenum (frenotomy) 

• 40819 — Excision of labial or buccal frenum (frenectomy) 

• 41115 — Excision of lingual frenum (frenectomy) 

Common ICD-10 diagnosis codes (select based on documented findings) 

• Q38.1 — Ankyloglossia (congenital tongue-tie) 

• R13.10 — Dysphagia, unspecified 

• R47.89 — Other speech disturbances 

• R63.3 — Feeding difficulties 

• R49.0 — Dysphonia / articulation difficulty 

 

Letter of Medical Necessity (LMN): narrative example (not a form) 

“The patient presents with restricted lingual movement consistent with ankyloglossia (Q38.1). Findings include impaired latch/feeding efficiency and articulation difficulty. Conservative measures (feeding modifications, oral exercises) have been insufficient. A lingual frenectomy (41115) is medically necessary to restore tongue mobility, improve swallowing/breathing, and support normal oral function.” 

Helpful attachments for medical claims 

• Pre-/post-op photos or relevant imaging 

• Provider progress notes documenting functional limitations 

• Therapy reports (lactation, feeding, myofunctional therapy, SLP) 

• Post-op instructions and follow-up note 

• Signed consent and plan of care 

 

Documentation Checklist (Use for Every Claim) 

• Diagnosis, site, and type of procedure (incision vs. excision) clearly documented 

• Pre- and post-op images (as available) 

• Narrative or LMN tying symptoms to function and expected improvement 

• Relevant therapy evaluations or progress notes (Myo/SLP/Lactation) 

• Pre-authorization documentation if required 

• For dental: periodontal charting as applicable; orthodontic context if relevant 

• Attachments labeled cleanly (e.g., “Clinical Photos,” “Provider Narrative,” “Therapy Evaluation”) to streamline payer review 

 

Average Cost and Coverage Considerations 

Typical fee range is $500–$1,500 per frenectomy, varying with complexity, anesthesia, and setting. Coverage depends on plan benefits, indication, and documentation quality. When in doubt, verify both dental and medical benefits and communicate expected out-of-pocket ranges with patients before treatment. 

 

Training the Team (Consistency = Fewer Denials) 

• Standardize your narratives (one dental, one medical template your team can tailor). 

• Create an attachment checklist inside your PMS/claims workflow. 

• Align clinical and billing teams on incision vs. excision definitions and matching codes. 

• Build a pre-auth cadence appropriate to your payers. 

• Monitor early-cycle EOBs to catch and correct patterns quickly. 

 

Learn from the Leader in Functional Release 

Advance your mastery of both the clinical and administrative aspects of frenectomy.
Join Dr. Kacy Jo at The Vivos Institute for Hands-On Frenectomy & Functional Release Training. Learn surgical protocols, DEKA Laser applications, LMN and narrative best practices, and billing workflows that align with airway-focused practice success. 

2026 Course Enrollment Now Open
Location: The Vivos Institute – Denver, CO
Explore Courses and Register →