Frenotomy (tongue tie release)

Frenotomy (tongue tie release)

Anterior Tongue Tie
Some of our doctors perform releases of tongue and lip tie, called frenotomy. This is a simple procedure done in office as part of a comprehensive feeding evaluation. We can release anterior and posterior tongue ties, as well as most upper lip ties (maxillary labial frenum).
Before scheduling a frenotomy, please check with your insurance to verify coverage. The following codes will be useful:
  • Procedure (CPT) code for tongue tie release: 41010
  • Procedure (CPT) code for lip tie release: 40819 or 40806
  • Diagnosis code (ICD10, on/after October 1, 2015): Q38.1 (tongue tie) and/or Q38.0 (lip tie)
  • Physician:            Elias Kass, ND, LM, CPM, tax ID 27-3741565, NPI 1245546100
  • Dr Kass is a Naturopathic Physician, so please make sure that these services are covered when performed by a Naturopathic Physician.

Insurance specific notes:

  • As of Jan 1, 2018, I am out of network with Cigna, as they do not cover the frenotomy procedures. Cigna patients can pay for the visits at the time of service.
  • CHPW (Community Health Plan of Washington) requires a referral from the patient’s primary care provider. This referral must be faxed by your baby’s PCP to CHPW (fax number: 206-652-7076)  and approved before you can schedule with us.

Please do not schedule appointments you do not intend to keep. When you cancel with less than 24 hours notice, or don’t show up for your appointment, you are denying another family the opportunity to be seen and will be billed $100 for a no-show. This cost is not covered by insurance.

Before your visit:

  • Fill out online forms. Do baby’s forms first. The forms include agreements/signatures, as well as medical histories.
  • Confirm insurance benefits. If we bill your insurance, but your insurance does not cover the procedure, or does not cover Dr Kass, you may be billed the entire cost of the visit directly. Time of service pricing is only available if you pay at the time of service.
  • Collect information about your baby’s weights, including birth weight, lowest weight, and any recent weights, along with the dates they were weighed. This information helps us understand how your baby has been growing.
  • Vitamin K is very important for blood clotting. We strongly recommend baby have received vitamin K prior to the visit.

The day of the visit:

  • Avoid white or precious clothes for either baby or the breastfeeding parent
  • Arrive 15 minutes before your appointment time to fill out any remaining forms and have your insurance added to the system.
  • Baby must eat after the procedure, so please bring whatever your baby currently uses to eat.

Please bring to the visit:soothie pacifier

  • if you are breastfeeding, please bring whatever you use for breastfeeding, including nipple shields, SNS, etc. If breastfeeding is very challenging or difficult to do while baby is upset, and you typically use a bottle in that situation, please bring bottles and milk or formula as well.
  • if you are bottle feeding, please bring bottles of expressed milk or formula.
  • your baby’s weights, including birth weight, lowest weight, and any recent weights, along with the dates they were weighed.
  • a pacifier — Soothie or Gumdrop type for post-procedure exercises
  • infant Tylenol (acetaminophen)

Because we try to evaluate and treat in the same 60 minute visit, it’s important to make the best use of your visit time by filling out all the required forms online before arriving at the office. The receptionist who schedules your appointment will instruct you in how to log on to the the patient portal to fill out these forms. This includes agreeing to clinic policies and filling out brief health histories for both parent and baby. Arrive 15 minutes before your appointment time to allow enough time for your insurance to be entered.

Recent article by Dr Kass about tongue tie: Research Review: Are There Any Benefits to Performing an Early Frenotomy on Newborns?



Frenotomy Referral: It’s helpful to fill out and fax this form ahead of time. This allows the registration and scheduling process to be streamlined. This form is especially important for urgent referrals or where you have called ahead to secure an appointment.

Patients with CHPW must have formal referral sent to our office before their appointment. Fax: 206-363-5555.