Bronchial Thermoplasty (BT) Clinical Policy
Customize your policy alerts
Sign up for Arizona Complete Health Policy CP.MP.110 alerts
Get alerted when Policy CP.MP.110 changes without checking for updates manually.
Monitor payer policy activity
Defines medical necessity and coverage stance for bronchial thermoplasty as a therapeutic option for severe persistent asthma for members of health plans affiliated with Centene/AZ Complete Health.
No material clinical or coverage changes in this revision.
Coverage Determinations and Stance
Investigational / Not Proven
Covered when ALL of the following are met:
This is the explicit coverage determination in the document.
The policy for health plans affiliated with Centene Corporation® states that the long‑term safety and effectiveness of bronchial thermoplasty has not been proven for severe asthma or any other indications. As a result, bronchial thermoplasty is treated as investigational/unsupported under this clinical policy.
Coverage decisions and benefit administration are governed by the terms and conditions of the applicable coverage documents and by state and federal requirements. When state Medicaid coverage provisions conflict with this clinical policy, the state Medicaid provisions take precedence over the policy.
Procedure and Billing Codes
Provider Responsibilities, Prior Authorization, and Documentation
Prior authorization required for bronchial thermoplasty
Bronchial thermoplasty is designated investigational/unproven in this clinical policy and therefore requires prior authorization review consistent with the plan's investigational procedure policies.
Use this policy as a guide for prior authorization decisions
This clinical policy is intended to provide a guide to medical necessity and is used to assist in making coverage decisions and administering benefits; prior authorization determinations are made in accordance with the Health Plan's coverage documents and administrative policies.
Require optimization of medical therapy (and consideration of biologics) before BT
Bronchial thermoplasty should only be considered after members have received optimal medical therapy and after consideration of biologic treatments for severe asthma; selection should involve an asthma specialist and treatment at a specialist center when appropriate.
- Consider BT only for adults (aged 18 and over) with severe asthma who remain uncontrolled despite optimal medical therapy.
- Specialist assessment and treatment in a center with appropriate resources (including ICU access) are recommended.
No specific step therapy algorithm provided
The policy text does not specify a formal step therapy algorithm or required medication sequence for bronchial thermoplasty prior authorization.
Document procedure using CPT 31660 or 31661
When reporting bronchial thermoplasty, document the procedure with the referenced CPT codes: 31660 for bronchial thermoplasty, one lobe, and 31661 for two or more lobes; follow current professional coding guidance prior to claim submission.
Follow coverage documents, laws, and exercise professional judgment
Providers must follow applicable coverage documents, state and federal requirements, and Health Plan administrative policies when seeking authorization or providing BT; exercise professional medical judgment and note that state Medicaid provisions take precedence if they conflict with this policy.
- Coverage decisions are subject to all terms, conditions, exclusions and limitations of the coverage documents.
- Providers are expected to exercise professional medical judgment and are responsible for member care.
- For Medicaid members, state Medicaid provisions take precedence when in conflict.
Investigational / not proven — potential basis for denial
The policy reiterates an investigational/unproven stance: it states the long-term safety and effectiveness of bronchial thermoplasty has not been proven for severe asthma or any other indications, which may support an investigational determination or denial.
Coverage decisions subject to contract terms and law
Coverage and benefit administration for bronchial thermoplasty are subject to the terms, conditions, exclusions, and limitations of the Health Plan's coverage documents and applicable law; the Health Plan makes no payment guarantees and may change or withdraw this policy.
- Coverage decisions are governed by the member's evidence of coverage, certificate of coverage, policy, or contract of insurance.
- If state or federal legal/regulatory requirements conflict with this policy, law and regulation govern.
Clinical Background and Context
Bronchial thermoplasty (BT) is a bronchoscopic procedure that delivers radiofrequency energy to the airways with the intent of reducing airway smooth muscle. The procedure is performed bronchoscopically and targets airway smooth muscle to decrease bronchoconstriction in patients with severe persistent asthma.
Key Terms and Trial Summaries
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.