CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Bronchial thermoplasty for asthma (coverage criteria)

This policy governs coverage and medical necessity determinations for bronchial thermoplasty as a treatment for asthma for Blue Cross Blue Shield - Rhode Island products, including distinctions for Medicare (BlueCHiP for Medicare) and commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBronchial thermoplasty for asthma (coverage criteria)

Policy CodePolicy N/A

Change TypeNo material clinical or coverage changes

Effective Date02|03/2015

Next Review DateN/A

Key ActionVerify member-specific benefits and eligibility via the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement before proceeding.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3RCTs cited

up to 5 yrssafety data duration

20%UK registry safety events

31660covered CPT code

31661not covered code

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.

Coverage Criteria — Bronchial Thermoplasty

Overall coverage stance

Policy coverage statements for bronchial thermoplasty:

BlueCHiP for Medicare: Bronchial thermoplasty for the treatment of asthma is not covered as the evidence is insufficient to determine the effects of the technology on health outcomes.

Commercial Products: Bronchial thermoplasty for the treatment of asthma is not medically necessary as the evidence is insufficient to determine the effects of the technology on health outcomes.

CPT code 31661 (Bronchoscopy with bronchial thermoplasty, 2 or more lobes) is not covered for BlueCHiP for Medicare and is listed as not medically necessary for Commercial products.

For Commercial products, bronchial thermoplasty is considered not medically necessary. The policy concludes the evidence is insufficient to determine effects on health outcomes, citing limited sham-controlled efficacy data, uncertain magnitude of benefit, and substantial adverse events reported in trials and observational data.

Provider Actions & Billing Rules

Prior Authorization

Not applicable

Step Therapy

Position in Stepwise Therapy

Bronchial thermoplasty is intended as a supplemental treatment for patients with severe persistent asthma (steps 5 and 6 in the stepwise approach to care).

Note

Benefit Verification

Benefits and eligibility vary by contract. Providers should verify member-specific benefits, eligibility, and any applicable medical necessity requirements with the member's plan prior to scheduling services.

Verify benefits in the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement.
Contact the provider call center for member-specific benefit and eligibility information.

Denial Risk

Coverage / Denial Risk

BlueCHiP for Medicare: Bronchial thermoplasty for the treatment of asthma is not covered. Commercial Products: Bronchial thermoplasty for the treatment of asthma is considered not medically necessary.

BlueCHiP for Medicare — Not covered.
Commercial Products — Not medically necessary.

Background

Asthma is a chronic heterogeneous airway disease characterized by bronchial hyperresponsiveness, airway inflammation, and reversible airflow obstruction. Bronchial thermoplasty delivers controlled radiofrequency thermal energy to reduce airway smooth muscle mass and is proposed as an adjunctive therapy for patients with severe persistent asthma who remain refractory to high-intensity medical therapy (steps 5–6). Evidence includes randomized trials and observational studies with safety follow-up up to five years, but long-term sham-controlled efficacy data are lacking.

Definitions

Bronchial thermoplasty — procedure definition

Procedure nameBronchial thermoplasty

ModalityDelivery of controlled radiofrequency energy via a catheter passed through a bronchoscope

Target tissueDistal airways airway smooth muscle (to reduce smooth muscle mass)

Typical energy/temperature and treatment areaHeats tissue to about 65°C over a 5-mm area

Treatment courseTypically performed as three outpatient procedures about three weeks apart

Severe persistent asthma — definition

DefinitionSevere persistent asthma: asthma requiring high‑intensity, step 5 or 6 guideline-based pharmacologic therapy (e.g., high‑dose inhaled corticosteroid plus long‑acting beta‑agonist and possibly oral corticosteroids)

Clinical featuresBronchial hyperresponsiveness, airway inflammation, and reversible airflow obstruction

Treatment intentPatients with asthma inadequately controlled on high‑intensity medical therapy may be considered for supplemental treatments such as bronchial thermoplasty