Surgery of the Lingual Frenulum (frenectomy/frenotomy/frenuloplasty)
North Carolina Medicaid clinical coverage policy that defines medical necessity criteria, prior approval, provider billing and coding, and limitations for surgery of the lingual frenulum (ankyloglossia). Applies statewide to NC Medicaid beneficiaries, includes EPSDT provisions for beneficiaries under 21.
Prior approval age threshold clarified from 'over 1 year of age' to '2 years of age and older' (09/01/2024).
Definitions previously in subsection 5.2.2 were moved to Section 1.0 and updated (09/01/2024).
Administrative/template updates across policy to align with Clinical Policy Development template; once-per-lifetime limit moved to Attachment A (09/01/2024).