# Frenectomy Billing Codes: D7960, D7961 and CPT 40819

> Understand frenectomy billing codes D7960, D7961, and CPT 40819 to navigate insurance claims and patient costs. Learn the difference between medical and dental

Canonical: https://frenectomyguide.com/articles/frenectomy-billing-codes

Last updated: 2026-10-31

## Key clinical takeaways

- A frenectomy is a minor surgical procedure to release a tight or restrictive frenulum in the mouth.
- The three primary codes you will encounter are D7960, D7961, and 40819.
- The difference lies in the anatomical location of the frenulum being treated.
- CPT code 40819, “Excision of frenum, any type,” is the standard code used to bill medical insurance for a frenectomy.
- The billing code used is the single largest factor determining what you pay.

## Quick answer

A frenectomy is a minor surgical procedure to release a tight or restrictive frenulum in the mouth. The billing codes used are D7960 (frenectomy for a labial or buccal frenum), D7961 (frenectomy for a lingual frenum, or tongue-tie), and CPT 40819 (excision of frenum, any type, under medical insurance). The correct code depends on the type of frenulum released and whether the provider bills medical or dental insurance, which directly impacts your out-of-pocket cost.

## At a glance

- **D7960** is the American Dental Association (ADA) code for the surgical removal of a labial (lip) or buccal (cheek) frenum.
- **D7961** is the ADA code for the surgical removal of a lingual (tongue) frenum, which is the procedure for tongue-tie.
- **CPT 40819** is the American Medical Association code used by physicians and surgeons to bill medical insurance for any frenectomy procedure.
- **Cost Range**: A simple frenectomy can range from $500 to $3,000 out-of-pocket, heavily influenced by insurance coverage, provider type, and anesthesia.
- **Coverage Variance**: Medical insurance may cover a frenectomy if deemed medically necessary (e.g., for infant feeding difficulties), while dental insurance may classify it as a surgical benefit.
- **Common Denial**: Claims are often denied due to incorrect coding, lack of pre-authorization, or the procedure being deemed not medically necessary by the insurer's criteria.

## What are the main frenectomy billing codes?

The three primary codes you will encounter are D7960, D7961, and 40819. D7960 and D7961 are Current Dental Terminology (CDT) codes maintained by the American Dental Association. These are used by dentists and oral surgeons when submitting claims to **dental insurance** plans. CPT 40819 is a Current Procedural Terminology code maintained by the American Medical Association. This code is used by physicians (such as ENTs, pediatricians, or oral surgeons acting as physicians) when submitting claims to **medical insurance** plans.

The choice of code is not up to the patient but is determined by the provider's license, the type of insurance they are credentialed with, and the specific nature of the procedure. Using the wrong code can lead to claim denials, so it's crucial your provider's billing staff understands these distinctions.

## D7960 vs. D7961: What's the difference?

The difference lies in the anatomical location of the frenulum being treated.

**D7960** is used for a **labial or buccal frenectomy**. This procedure addresses a tight band of tissue connecting the lip to the gums (labial) or the cheek to the gums (buccal). A prominent maxillary labial frenum is sometimes associated with a gap between the front teeth. You can learn more about this specific anatomy in our guide on the [buccal frenum](https://frenectomyguide.com/articles/buccal-frenum/).

**D7961** is used for a **lingual frenectomy**. This is the procedure commonly referred to as a tongue-tie release, which involves cutting the band of tissue (lingual frenulum) under the tongue. This code is applied whether the procedure is performed with scissors, laser, or electrocautery. For a deeper look at the procedure itself, see our article on the [lingual frenectomy](https://frenectomyguide.com/articles/lingual-frenectomy/) process.

| Code | Type | Description | Typical Use Case |
| --- | --- | --- | --- |
| **D7960** | Dental (CDT) | Frenectomy – labial or buccal | Releasing a tight upper lip-tie that may cause a gum gap or interfere with orthodontics. |
| **D7961** | Dental (CDT) | Frenectomy – lingual | Releasing an [ankyloglossia (tongue-tie)](https://frenectomyguide.com/articles/ankyloglossia-treatment/) to improve tongue mobility for feeding, speech, or oral function. |
| **CPT 40819** | Medical (CPT) | Excision of frenum, any type | Billing medical insurance for a frenectomy deemed medically necessary, often for infant feeding difficulties. |

## CPT code 40819 for medical insurance

CPT code 40819, “Excision of frenum, any type,” is the standard code used to bill medical insurance for a frenectomy. This is critical because many conditions treated by frenectomy, especially in infants, are considered medical rather than dental problems. For example, a tongue-tie causing [poor weight gain](https://frenectomyguide.com/articles/tongue-tie-poor-weight-gain/) or severe [nipple pain](https://frenectomyguide.com/articles/tongue-tie-nipple-pain/) during breastfeeding is a functional, medical issue.

Medical insurance coverage under this code is not automatic. It requires the provider to submit documentation proving **medical necessity**. This often includes:

- A formal diagnosis (e.g., ankyloglossia).
- Records of associated functional problems (feeding logs, weight charts, notes from a lactation consultant).
- A treatment plan explaining why the procedure is required.

The coverage criteria, co-pays, deductibles, and need for pre-authorization vary drastically between insurance plans. Always verify benefits directly with your medical insurer before the procedure.

## How billing codes affect your out-of-pocket cost

The billing code used is the single largest factor determining what you pay. Here's a step-by-step breakdown of how it works:

1. **Provider Type & Insurance Contract:** A dentist will bill your dental insurance using D7960/D7961. An ENT or pediatric surgeon will bill your medical insurance using CPT 40819. Your out-of-network costs will be higher.
2. **Plan Benefits & Medical Necessity:** Check if your plan covers the relevant code. Medical plans often require the “medical necessity” hurdle to be cleared for CPT 40819. Dental plans may classify D7961 as a “surgical” procedure subject to a 50% co-insurance after your deductible.
3. **Pre-Authorization:** Many plans require pre-approval for surgical codes. Your provider's office should handle this, but you should confirm it's been obtained.
4. **Claim Submission:** After the procedure, the provider submits the claim with the appropriate code and supporting documentation.
5. **Explanation of Benefits (EOB):** You and the provider receive an EOB from the insurer detailing what was covered, denied, and your patient responsibility.
6. **Patient Responsibility:** You pay the remaining balance, which could be a co-pay, co-insurance, deductible, or the full amount if the claim is denied.

Understanding this process can help you avoid surprises. For a comprehensive look at expenses, read our guide on [frenectomy cost](https://frenectomyguide.com/articles/frenectomy-cost/).

## Medical vs. dental insurance for frenectomy

Navigating which insurance applies is a common challenge. The general principle is that **medical insurance** covers the diagnosis and treatment of disease or dysfunction, while **dental insurance** covers care for the teeth and supporting structures.

- **Medical Insurance (CPT 40819):** Typically the primary payer for infant frenectomies performed to resolve feeding disorders, failure to thrive, or maternal complications like mastitis. It may also cover procedures for speech impediments or sleep-disordered breathing in older children and adults when supported by appropriate diagnoses. The process of getting a diagnosis often starts with knowing [who diagnoses tongue-tie](https://frenectomyguide.com/articles/who-diagnoses-tongue-tie/).
- **Dental Insurance (D7960/D7961):** Often the primary payer for frenectomies performed for periodontal reasons (like gum recession), in preparation for or following orthodontic treatment ([frenectomy before braces](https://frenectomyguide.com/articles/frenectomy-before-braces/)), or for general oral health.

Many families find they need to submit claims to both insurers, a process called coordination of benefits. It's not uncommon for a claim to be denied initially; knowing how to appeal a [frenectomy claim denied](https://frenectomyguide.com/articles/frenectomy-claim-denied/) is an important skill.

## What to do before your frenectomy procedure

To minimize billing issues and unexpected costs, take these proactive steps:

1. **Get a Clear Diagnosis and Procedure Description:** Ask your provider for the exact diagnosis (e.g., “Ankyloglossia”) and which procedure code (D7961 or 40819) they intend to use.
2. **Contact Both Insurers:** Call your medical and dental insurance companies. Ask: “Does my plan cover procedure code [40819/D7961] for the diagnosis of [ankyloglossia]? What are my benefits, deductible, co-insurance, and is pre-authorization required?”
3. **Request a Pre-Determination:** For dental codes, ask your provider to submit a pre-determination of benefits. This is a pre-claim that gives you a reliable estimate of what the insurance will pay.
4. **Get Cost Estimates in Writing:** Ask the provider's office for a detailed, written estimate of all costs, including the surgeon's fee, facility fee, and anesthesia.
5. **Document Everything:** Keep records of all calls with insurers (reference numbers, representative names), emails, and written correspondence.
6. **Plan for Out-of-Pocket Costs:** Based on your research, set aside funds in an HSA or FSA, or budget for the likely patient responsibility amount.

## Frequently Asked Questions

### Does Medicaid cover frenectomy with these codes?

Coverage varies by state. Many state Medicaid programs cover frenectomy (CPT 40819) for infants when deemed medically necessary for feeding. Coverage for older children and adults is more restrictive. You must check with your specific state Medicaid managed care plan.

### Can I use HSA/FSA funds for a frenectomy?

Yes, Health Savings Account (HSA) and Flexible Spending Account (FSA) funds can typically be used for frenectomy procedures, as they are considered eligible medical expenses by the IRS, especially when treating a diagnosed medical condition like ankyloglossia.

### What if my dentist uses a laser? Is there a different code?

No, the procedure code (D7960, D7961, 40819) describes the surgical removal of the frenulum, regardless of the instrument used (scissors, laser, electrocautery). The laser is considered a method, not a different procedure.

### Why was my claim for CPT 40819 denied?

Common reasons include: lack of pre-authorization, insufficient documentation of medical necessity, the procedure being considered “routine” or “cosmetic” by the insurer, or the provider being out-of-network. You have the right to appeal the denial.

### Is a frenectomy for a lip-tie billed differently?

Yes, a labial frenectomy for a lip-tie is typically billed under the dental code D7960. If performed by a physician for a functional reason (e.g., difficulty closing the lips), it could be billed under CPT 40819, but this is less common than for tongue-tie.

### What is the difference between a frenectomy and a frenotomy?

A frenotomy (often coded as D7970) is a simpler, partial incision of the frenulum, frequently performed on newborns without anesthesia. A frenectomy is a more complete excision of the tissue. For a detailed comparison, see our article on [frenotomy vs frenectomy](https://frenectomyguide.com/articles/frenotomy-vs-frenectomy/).

## References

1. American Dental Association. (2025). *Current Dental Terminology (CDT)*. Code Descriptions for D7960, D7961.
2. American Medical Association. (2025). *CPT Professional Edition*. Code Description for 40819.
3. American Academy of Pediatrics. (2023). Clinical Report on Ankyloglossia in Infants and Children.
4. American Academy of Otolaryngology-Head and Neck Surgery. (2024). Position Statement on Ankyloglossia.
5. Centers for Medicare & Medicaid Services. (2025). *National Coverage Determinations & Local Coverage Determinations*.

## Medical disclaimer

This article is for informational purposes only and is not medical advice. It does not constitute a patient-provider relationship. You should consult with a qualified healthcare professional for diagnosis, treatment, and answers to your personal medical questions. Always seek the advice of your surgeon, physician, or other qualified health provider regarding a medical condition or procedure. Reviewed by the frenectomyguide.com editorial team · Last updated 2026-10-31.

## Related guides in this series

- [Who Diagnoses a Tongue-Tie? Pediatrician, Dentist or Lactation Consultant](https://frenectomyguide.com/articles/who-diagnoses-tongue-tie) — The short answer to who diagnoses tongue tie is that a pediatrician, a dentist (often a pediatric dentist), or an International Board Certified Lactation Consultant (IBCLC) can identify it, dependi…
- [What to Eat After a Frenectomy](https://frenectomyguide.com/articles/what-to-eat-after-frenectomy) — After a frenectomy—a procedure to release a tight frenulum in the mouth—you should eat soft, cool, and bland foods that require minimal chewing. Ideal choices include yogurt, applesauce, lukewarm b…
- [Upper Lip Tie in Adults: Symptoms and Treatment](https://frenectomyguide.com/articles/upper-lip-tie-adults) — An upper lip tie in adults is a tight or thick band of tissue (the labial frenulum) connecting the upper lip to the gums, which can restrict normal lip movement. While often addressed in infancy, m…

## About this guide

This medical guide follows generally accepted clinical guidance for oral restrictions and is informational only. It is not a substitute for personalized medical advice. Always discuss diagnosis and treatment with a qualified physician.

## Related
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- [What to Eat After a Frenectomy](https://frenectomyguide.com/articles/what-to-eat-after-frenectomy)
- [Upper Lip Tie in Adults: Symptoms and Treatment](https://frenectomyguide.com/articles/upper-lip-tie-adults)
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