Insurance Policy and Fee Schedule


A lingual and labial frenectomy/frenotomy/frenulectomy procedure is performed to aid with proper nutrition, growth and development of the baby. The procedure is performed to allow for the tongue and/or the lip to function properly during swallowing and/or latching at the breast or bottle.

Our office does NOT accept any form of medical or dental insurance for payment or reimbursement.  We are a strict fee-for-service office and all fees are due the same day as the appointment.

Insurance coverage for this procedure should be claimed from your medical or dental insurance policy. If this procedure is covered under your medical or dental insurance plan, you (the subscriber) will need to submit the claim and pursue reimbursement directly from the insurer.

The three ways you could possibly get reimbursement from your insurance carrier are:


  1. Mother’s medical insurance policy.  Typically the procedure must be performed in the first 30 days of life while the infant is still covered under the mother’s policy, if this option is used.
  2. Child's medical insurance policy.
  3. Child’s dental insurance policy.


Fees for frenectomy treatment are due in full at the time of service.  We accept Credit Cards, Debit Cards, HSA Cards and cash. 

The costs for the full work-up exam and assessment is $125.00. 

The first procedure (lingual frenulectomy) is $400.00.  
If a second procedure site (labial frenulectomy) is needed to be performed is $175.00 additional.


For example: Exam and lingual frenulectomy is $525.00
                      Exam, lingual and labial frenulectomy is $700.00


Here is some information that you may need while seeking coverage information:


Dental Insurance Codes for Reimbursement: ADA Code

D 0150 – Comprehensive Oral Evaluation
D 7960 – Frenulectomy

(The code for the frenulectomy is the same for the Upper Maxillary Labial Frenulum (UL) and the Lower Mandibular Lingual Frenulum (LL).  Depending on your dental insurance carrier they may require certain descriptive words to differentiate between the arches, either upper (UL or UA) or lower (LL or LA).

Medical Insurance Codes for Reimbursement: ICD 10 and CPT Codes

ICD 10 Code: Diagnosis of Ankyloglossia (Tongue tie) Q38.1
ICD 10 Code: Diagnosis of Restricted Labial Frenulum (Lip Tie) Q38.0

Procedure CPT Code: Labial or Upper Lip Frenulum / Frenotomy: 40806 or 40819
Procedure CPT Code: Lingual or Lower Tongue Frenulum / Frenotomy: 41010

Insurance & Fees