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    v1.0.28
    OpenPayerPolicy UpdatesPulmonologyAmeriHealth Caritas Bronchial Thermoplasty Coverag…
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    CurrentAmeriHealth CaritasPolicy CCP.1058

    Bronchial Thermoplasty for Severe Asthma

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    Defines medical necessity criteria and coverage stance for bronchial thermoplasty (Alair) in adults with severe, persistent asthma and describes contraindications and background evidence; applies to AmeriHealth Caritas coverage determinations.

    Policy Summary
    PayerAmeriHealth Caritas
    PolicyBronchial Thermoplasty for Severe Asthma
    Policy CodePolicy CCP.1058
    Change TypeContraindications revisedbiologic requirement clarified
    Effective DateMar 20, 2026
    Last ReviewMar 1, 2026
    Next Review DateJul 1, 2027
    Key ActionObtain prior authorization and document failure of or contraindication to biologic therapy plus confirmation of severe asthma and absence of contraindications.
    SourceLink
    POLICY UPDATE CHANGES

    The list of contraindications in the coverage criteria was modified based on manufacturer information.

    Coverage language affirms bronchial thermoplasty may be medically necessary for severe asthma when all specified criteria are met, including failure of or contraindication to biologics.

    18+minimum age for therapy
    3treatment sessions
    >=3 wkrecovery interval

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Alairdevice referenced
    Nonepolicy limitations

    Coverage Criteria for Bronchial Thermoplasty

    Initial therapy — Covered when ALL of the following are met

    Covered when ALL of the following are met

    Overall coverage conditions: The member has a confirmed diagnosis of severe asthma.
    Overall coverage conditions: Severe asthma persists despite adherence to appropriate pharmacologic and non-pharmacologic interventions, including high-dose inhaled corticosteroids and long-acting beta agonists, and the member has failed treatment with, or has contraindications to, biologics.
    Overall coverage conditions: Member does not have a comorbidity that could affect asthma control; specifically none of the following are present or they are well-controlled: gastroesophageal reflux disease, postnasal drip, or obstructive sleep apnea; active smoking; vocal cord dysfunction; chronic sinus disease or frequent chest infections; or other uncontrolled comorbidities.
    Overall coverage conditions: Medication adherence is confirmed and proper inhaler technique is used and reinforced.
    Overall coverage conditions: Member is able to undergo bronchoscopy safely.
    Overall coverage conditions: Contraindications to bronchial thermoplasty are ruled out (including, but not limited to: implantable electronic device; member under 18 years of age; prior bronchial thermoplasty in the same area; active respiratory infection; asthma exacerbation or change in systemic corticosteroid dose for asthma within the past 14 days; known coagulopathy).

    Criteria reflect guidance and manufacturer contraindications.

    Coverage for bronchial thermoplasty excludes patients who meet any of the manufacturer-listed contraindications. Specifically, members under 18 years of age, those with an implantable electronic device, individuals with a history of prior bronchial thermoplasty in the same treatment area, those with an active respiratory infection, and members with a known coagulopathy are excluded until contraindications are resolved or no longer present. Also exclude members who have had an asthma exacerbation or a change in systemic corticosteroid dose for asthma within the past 14 days.

    Use of bronchial thermoplasty is not medically necessary when the policy’s coverage criteria are not fully met. This includes situations where the member does not have a confirmed diagnosis of severe asthma, has not had optimization of high‑dose inhaled corticosteroids plus long‑acting beta agonists, or has not failed (or is not contraindicated to) biologic therapy as required by the criteria. The procedure is also not medically necessary when uncontrolled comorbidities that could affect asthma control exist (for example, inadequately treated gastroesophageal reflux, uncontrolled obstructive sleep apnea, active smoking, vocal cord dysfunction, chronic sinus disease, or frequent chest infections), or when any contraindication to bronchial thermoplasty is present. Documentation failures or lack of required clinical optimization may also result in denial.

    Coding and Procedural Information

    Related procedure codesCPT
    31660Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe
    31661Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes
    Minimum age
    Minimum age>= 18 years
    Applies toAdults 18 years and older with severe, persistent asthma
    Source guidanceDevice labeling and clinical trials specify use in individuals 18 years and older

    Provider Requirements and Prior Authorization

    Prior Authorization

    Obtain prior authorization for bronchial thermoplasty (CPT 31660/31661)

    Prior authorization is required for bronchial thermoplasty procedures billed with bronchoscopy with bronchial thermoplasty codes; approval must confirm that the policy criteria are met.

    • Relevant CPT codes: 31660 (bronchial thermoplasty, 1 lobe) and 31661 (bronchial thermoplasty, 2+ lobes).
    Step Therapy

    Stepwise therapy required; trial of biologics must have failed or be contraindicated

    Patients must have persistent severe asthma despite optimized pharmacologic and non-pharmacologic therapies, including high‑dose inhaled corticosteroids and long‑acting beta agonists, and must have failed treatment with—or have a contraindication to—biologic therapies before bronchial thermoplasty is considered.

    • Confirm optimized therapy including high‑dose inhaled corticosteroids + long‑acting beta agonist.
    • Document trial and failure of biologic therapy, or a documented contraindication to biologics.

    Background and Scope

    Asthma is a chronic airway disorder characterized by reversible airflow obstruction from inflammation and bronchial hyperreactivity. Bronchial thermoplasty is an endoscopic radiofrequency procedure (the FDA‑approved Alair system) intended to reduce bronchial smooth muscle and improve control in adults with severe, persistent asthma that remains uncontrolled despite long‑acting bronchodilators and glucocorticoids. The procedure is typically performed by a pulmonologist in three treatment sessions under moderate sedation or general anesthesia, with a minimum recovery interval of at least three weeks between sessions.

    Definitions

    Bronchial thermoplasty — definition
    Procedure typeEndoscopic procedure applying radiofrequency energy to ablate bronchial smooth muscle
    MechanismEnergy delivered through an expandable array of electrodes to reduce airway constriction by ablating smooth muscle
    Indication contextIntended to treat severe, persistent asthma not well controlled by long-acting bronchodilators or glucocorticoids
    Alair Bronchial Thermoplasty System — definition
    Device nameAlair Bronchial Thermoplasty System
    Regulatory statusU.S. Food and Drug Administration–approved (2010)
    Manufacturer
    Policy Summary
    PayerAmeriHealth Caritas
    PolicyBronchial Thermoplasty for Severe Asthma
    Policy CodePolicy CCP.1058
    Change TypeContraindications revisedbiologic requirement clarified
    Effective DateMar 20, 2026
    Last ReviewMar 1, 2026
    Next Review DateJul 1, 2027
    Key ActionObtain prior authorization and document failure of or contraindication to biologic therapy plus confirmation of severe asthma and absence of contraindications.
    SourceLink
    On This Page
    Coverage Criteria for Bronchial ThermoplastyCoding and Procedural InformationProvider Requirements and Prior AuthorizationBackground and ScopeDefinitions
    Documentation Required

    Provide complete documentation of diagnosis, medication optimization, biologic trial/contraindication, comorbidity control, and contraindications

    Document the confirmed diagnosis of severe asthma, evidence of adherence to and optimization of high‑dose inhaled corticosteroids plus long‑acting beta agonists, trial of or contraindication to biologic therapy, control of comorbid conditions, and ability to undergo bronchoscopy with absence of listed contraindications.

    • Notes showing medication adherence and proper inhaler technique were confirmed and reinforced.
    • Records demonstrating comorbidities (e.g., GERD, smoking status, vocal cord dysfunction, chronic sinus disease) are absent or well controlled.
    • Documentation ruling out contraindications per manufacturer guidance (implantable electronic device, age <18, prior BT in same area, active respiratory infection, asthma exacerbation or systemic corticosteroid dose change within 14 days, known coagulopathy).
    Denial Risk

    Denial likely if criteria not met or contraindications/uncontrolled comorbidities present

    Requests may be denied if the member does not have confirmed severe asthma, has not failed or is not contraindicated to biologic therapy, has uncontrolled comorbidities affecting asthma control, cannot safely undergo bronchoscopy, or has any manufacturer-listed contraindication.

    • Contraindications that trigger denial include implantable electronic device, age under 18, prior bronchial thermoplasty in the same area, active respiratory infection, asthma exacerbation or change in systemic corticosteroid dose for asthma in the past 14 days, and known coagulopathy.
    • Uncontrolled comorbidities affecting asthma control (e.g., uncontrolled GERD, untreated obstructive sleep apnea, active smoking, vocal cord dysfunction, chronic sinus disease or frequent chest infections) are grounds for denial.
    Boston Scientific Corporation, Marlborough, Massachusetts
    Clinical usePerformed in three treatment sessions targeting different lung segments with >=3 weeks between sessions