Bronchial Thermoplasty
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This policy governs coverage of bronchial thermoplasty for treatment of asthma for Blue Cross Blue Shield of North Carolina members; it describes the policy stance, clinical background, coding, and supporting evidence for providers.
No material clinical or coverage changes in this revision.
Coverage Determination
Overall policy stance
Covered when ALL of the following are met:
BCBSNC does not provide coverage for investigational services or procedures.
Bronchial thermoplasty for the treatment of asthma is considered investigational for all applications.
Blue Cross Blue Shield of North Carolina does not provide coverage for services or procedures that are investigational. Because bronchial thermoplasty is designated as investigational for the treatment of asthma, BCBSNC will not authorize or reimburse this procedure or related services.
Applicable Service Codes
Provider Responsibilities and Billing Notes
Prior review required; applicable service codes
Prior review (prior authorization) is required for bronchial thermoplasty; applicable service codes listed in the policy are 31660, 31661, 31899, 0781T, 0782T, and C1886. The policy notes prior review was implemented effective 7/1/14 (notification given 7/1/14; effective date 9/30/14).
Placement in stepwise asthma care (steps 5–6)
Bronchial thermoplasty is described as a supplemental treatment option intended for patients with severe persistent asthma (NHLBI steps 5 and 6), i.e., for consideration in the stepwise asthma care algorithm after maximal pharmacologic therapy.
- Intended for severe persistent asthma (steps 5 and 6 per NHLBI stepwise pharmacologic approach)
- Full treatment course typically consists of three outpatient sessions approximately 3 weeks apart
Medical records and supporting documentation may be requested
BCBSNC may request medical records to determine medical necessity; when records are requested, letters of support or explanation can be useful but are not sufficient unless they include all specific information needed for the determination.
- Be prepared to provide medical records when requested for review of medical necessity
- Include all specific clinical information required — letters alone are not sufficient unless they contain the required details
Investigational — services not covered
Bronchial thermoplasty is considered investigational for all applications and BCBSNC does not provide coverage for investigational services or procedures; services determined to be investigational are not covered and are subject to denial and nonpayment.
- Do not bill expecting coverage for bronchial thermoplasty for asthma — policy stance is investigational for all applications
- Claims for investigational services may be denied and will not be reimbursed
Clinical Background
Bronchial thermoplasty is a procedure that delivers controlled radiofrequency energy to the distal airways with the intended clinical effect of reducing airway smooth muscle mass to decrease airway-mediated bronchoconstriction. A full course is typically delivered as three outpatient sessions, each about one hour and spaced roughly three weeks apart, treating airways approximately 3–10 mm in diameter (the right middle lobe is excluded).
Definitions and Key Terms
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