CurrentAmbetter NevadaPolicy CP.MP.110

Clinical Policy: Bronchial Thermoplasty

Defines medical necessity and coverage stance for bronchial thermoplasty (BT) as a treatment option for severe persistent asthma for health plans affiliated with Centene Corporation / Ambetter Nevada.

Policy Summary

PayerAmbetter Nevada

PolicyClinical Policy: Bronchial Thermoplasty

Policy CodePolicy CP.MP.110

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain prior authorization following Health Plan procedures when requesting coverage for bronchial thermoplasty; coverage is investigational.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2 CPT codesprocedure codes referenced for BT

10+ yearsfollow-up duration reported in BT10+ study

low-qualityevidence body per Hayes assessment

AIR2 RCT (n=288)largest referenced randomized controlled trial

Coverage and Policy Stance

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

The policy declares an implicit exclusion by stating that the long-term safety and effectiveness of bronchial thermoplasty has not been proven for severe asthma or any other indications. Because the evidence base is judged insufficient to establish BT as a standard therapy, the procedure is treated as investigational and is not supported for routine coverage under this clinical policy.

The policy’s statement that long-term safety and effectiveness has not been proven indicates an investigational stance. Practically, this means BT is considered unestablished care and that requests for coverage are likely to be denied or require strong justification per the Health Plan’s prior authorization procedures.

Coverage determinations for bronchial thermoplasty are governed by the member’s coverage documents and Health Plan procedures. Decisions are subject to all terms, conditions, exclusions and limitations of the coverage documents, as well as applicable state and federal requirements, and Health Plan-level administrative policies. Where state Medicaid provisions conflict with this clinical policy, those provisions take precedence.

Provider Requirements, Prior Authorization, and Administration

Prior Authorization

Prior Authorization Required

Prior authorization may be required. This policy is intended to guide medical necessity determinations and to assist in making coverage decisions and administering benefits; it does not guarantee payment. Providers should obtain any required prior authorization from the Health Plan before scheduling bronchial thermoplasty procedures.

Prior authorization rules and criteria are subject to the member's benefit documents and Health Plan administrative policies.
If prior authorization is required, provide clinical documentation demonstrating that criteria for medical necessity have been met.

Step Therapy

Sequencing and Candidate Selection

Providers should document that bronchial thermoplasty is being considered only after optimal medical therapy — including inhaled corticosteroids, long-acting bronchodilators, and other controller medications — has been optimized and after consideration of biologic therapies when clinically appropriate. BT is generally considered for adults (≥18 years) with severe, poorly controlled asthma despite optimal therapy and when biologics are unsuitable or have failed.

Document trials of optimized medical therapy and rationale for deeming biologic therapies unsuitable or ineffective.
Ensure assessment and referral are by or in consultation with an asthma specialist experienced in BT and that treatment will be performed in an appropriately resourced center.

Billing Rule

Coding and Claim Documentation

Follow current CPT coding guidance when submitting claims. The following CPT codes are commonly associated with bronchial thermoplasty; inclusion here is informational and does not guarantee coverage. Verify coding and modifier usage with the most recent coding manuals and payer billing instructions.

CPT 31660 — Bronchoscopy with bronchial thermoplasty, one lobe.
CPT 31661 — Bronchoscopy with bronchial thermoplasty, two or more lobes.
Include relevant supporting documentation (operative report, indication, prior authorization approval) with claims as required by the Health Plan.

Documentation Required

Documentation and Administrative Requirements

Requests for coverage and prior authorization must include complete clinical documentation per Health Plan administrative policies. The Health Plan may deny requests when long-term safety and effectiveness have not been demonstrated or when documentation does not support medical necessity. Follow local and plan-specific submission requirements, timelines, and appeals processes.

Provide complete medical records, relevant imaging, pulmonary function tests, symptom control assessments, and documentation of prior therapies tried and response.
Coverage decisions are subject to member benefit terms, state and federal regulations, and the Health Plan's administrative policies.

Denial Risk

Investigational/Denial Risk

Providers should be aware that this clinical policy represents an investigational stance for bronchial thermoplasty in indications where long-term safety and effectiveness remain unproven. This may place certain requests at higher risk for denial; include robust supporting evidence and rationale when requesting approval.

When BT is requested for indications outside the limited, evidence-supported population, clearly state clinical justification and reference peer-reviewed literature as appropriate.
Adhere to Health Plan appeals and peer review processes if initial requests are denied.

Clinical Background

Asthma is a chronic inflammatory disorder of the lower respiratory tract characterized by variable airflow obstruction and airway hyperresponsiveness driven by complex immunologic mediators. Bronchial thermoplasty (BT) is a bronchoscopic procedure that delivers controlled radiofrequency energy to the airway wall with the intent to reduce airway smooth muscle mass and thereby decrease bronchoconstriction. The procedure is typically performed in staged treatments targeting lobar airways under bronchoscopic guidance. Evidence to date includes randomized trials and long-term follow-up studies, but the policy concludes that long-term safety and effectiveness have not been proven, which limits the procedure’s acceptance as standard therapy.

Definitions and Key Trials

Bronchial thermoplasty (BT) — procedure definition

DefinitionBronchial thermoplasty (BT) is a bronchoscopic radiofrequency ablation procedure that applies thermal energy to airway walls to reduce airway smooth muscle cell mass, intended to decrease severe bronchoconstriction in severe persistent asthma.

Procedure modalityPerformed bronchoscopically with radiofrequency energy delivered to airway smooth muscle to achieve ablation/reduction of smooth muscle hypertrophy.

Therapeutic intentDesigned as a therapeutic option to reduce severe bronchoconstriction in patients with severe persistent asthma who remain symptomatic despite medical therapy.

Clinical settingTypically performed in specialized centers with expertise in interventional pulmonology and multidisciplinary severe asthma teams due to patient selection complexity and procedural expertise required.

AIR2 trial — key descriptor and outcomes (n=288)

Trial name and designAsthma Intervention Research Trial 2 (AIR2): a multicenter randomized, double‑blind, sham‑controlled trial enrolling 288 patients.

Primary outcomeAIR2 reported a statistically significant improvement in the Asthma Quality of Life Questionnaire (AQLQ) score in the BT group versus sham, but the magnitude fell below the predefined clinically meaningful threshold.

Other outcomesNo difference was observed between BT and sham in peak flow or FEV1; secondary outcomes and safety measures were criticized and remain controversial.

Health Plan — definition and policy applicability

Health Plan definition'Health Plan' means a health plan that has adopted this clinical policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any of such health plan's affiliates.

Policy roleThis clinical policy is a guide to medical necessity used to assist in coverage decisions and administering benefits; it is not a contract or guarantee of payment.

Applicability and limitsCoverage decisions are subject to the terms, conditions, exclusions and limitations of the member's coverage documents and to state and federal requirements; Medicaid and Medicare provisions may take precedence where applicable.