Bronchial thermoplasty
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Policy governing coverage and medical necessity criteria for bronchial thermoplasty in adults with severe persistent asthma, including required preconditions, contraindications, and procedural limits for Capital BlueCross-administered products.
No material clinical or coverage changes in this revision.
Coverage and Medical Necessity Criteria
Clinical coverage considerations
Policy references society guidance emphasizing selective use only for adults with severe persistent asthma who remain uncontrolled despite optimized therapy and specialty referral; recommend use within registry or clinical study.
Supported by ACAAI and GINA guidance; NAEPP issues a conditional recommendation against routine use and suggests registry/clinical trial setting if chosen.
Per GINA and NAEPP recommendations.
Contraindications that preclude coverage and may lead to denial include presence of a pacemaker, internal defibrillator, or other implantable electronic devices; known sensitivity to medications required to perform bronchoscopy (including lidocaine, atropine, or benzodiazepines); treatment of the same lung area previously with bronchial thermoplasty; active respiratory infection; asthma exacerbation or change in systemic corticosteroid dosing within the prior 14 days; and known coagulopathy. These conditions are listed as situations in which bronchial thermoplasty is considered not medically necessary or may be denied.
The National Asthma Education and Prevention Program (NAEPP) issued a conditional recommendation against bronchial thermoplasty for individuals age ≥ 18 years with persistent asthma based on low‑certainty evidence. The NAEPP statement notes that some adults who place a low value on potential harms and a high value on potential benefits may still choose the procedure, but recommends that clinicians offer bronchial thermoplasty only within a clinical trial or registry to collect long‑term outcomes.
Repeat bronchial thermoplasty procedures beyond the initial three treatment sessions are considered investigational/not medically necessary due to insufficient evidence demonstrating benefit. Performing additional treatment sessions outside the initial three‑procedure course may result in denial of coverage.
Because the NAEPP issues a conditional recommendation against routine use, many adults with persistent asthma will not be considered appropriate candidates for bronchial thermoplasty unless, after shared decision‑making, they accept the potential short‑term harms and uncertain long‑term effects. The guideline therefore supports offering the procedure in the context of a registry or clinical trial rather than routine clinical practice.
Regulatory & Coding
| FDA product code OOY | Alair Bronchial Thermoplasty System regulatory product code |
| 31660 | Procedure code for bronchial thermoplasty (listed) |
| J45.50 | Severe persistent asthma, uncomplicated |
Prior Authorization, Documentation, and Provider Requirements
Prior authorization required for bronchial thermoplasty
Bronchial thermoplasty requires prior authorization and is covered only when all medical necessity criteria in this policy are met, including completion of the three staged treatment sessions about three weeks apart and all specified clinical prerequisites (age, specialist management, lung function, exacerbation history, refractory therapy, smoking status).
- Three treatment sessions with ~3 weeks between sessions
- All listed medical necessity criteria must be documented prior to authorization
Map CPT 31660 to member’s benefits and preauthorization rules
Procedure code 31660 is listed in the policy; providers must verify the member’s specific health benefit plan for coverage and whether preauthorization is required for the submitted procedure code.
- Map procedure 31660 to the member’s plan benefits before scheduling or billing
- Benefit determinations (including preauthorization requirements) are governed by the member’s health benefit plan
Placement in treatment steps (Step 5–6 supplemental therapy)
Bronchial thermoplasty is intended as a supplemental treatment for patients at Step 5 or 6 of asthma therapy after optimization of pharmacologic therapy and specialty referral; consider only after trials of recommended add-on treatments and biologics when appropriate.
- Intended for severe persistent asthma (steps 5–6) after optimization of therapy
- Recommend referral to an asthma specialty center and consideration within registry/clinical study context per guidance
Candidate profile — symptomatic despite maximal medical therapy
Candidacy is limited to adult patients who remain symptomatic despite maximal medical therapy; the policy describes candidates as those with severe persistent asthma who continue to have significant symptoms and exacerbations despite optimized therapy.
- Patients symptomatic despite maximal therapy (daily symptoms, nightly awakenings, frequent rescue use, extreme activity limitation)
- Adult patients (age ≥18) only
Required clinical documentation — specialist management and therapy adherence
Document that the individual has been managed by an asthma specialist (pulmonologist or allergist/immunologist) for at least 6 months, has demonstrated adherence to optimal controller therapy (e.g., high‑dose ICS + LABA or chronic oral corticosteroids for ≥3 consecutive months), and that comorbidities and alternative diagnoses have been addressed.
- Specialist management ≥6 months with documentation of education and management of comorbidities
- Evidence of adherence to high‑dose ICS+LABA or chronic oral corticosteroids for at least three consecutive months
Exacerbation and lung function documentation required
Provide documentation of at least two asthma exacerbations in the prior 12 months (for example: oral systemic corticosteroid use, unscheduled office visit, ED visit, or hospitalization) and pre‑bronchodilator FEV1 >50% predicted.
- Record of ≥2 exacerbations in prior 12 months (systemic corticosteroids, unscheduled visit, ED visit, or hospitalization)
- Pre‑bronchodilator FEV1 >50% predicted
Check member’s health benefit plan for coverage and preauthorization
Providers and members should consult the member’s health benefit plan for information on coverage, exclusions, benefit limits, and preauthorization; the policy does not by itself guarantee coverage under a given plan.
- Benefit determinations depend on applicable health benefit plan language
- Contact Capital Blue Cross or consult the member’s plan for benefit specifics
Repeat procedures beyond the initial three sessions are investigational
Repeat bronchial thermoplasty procedures beyond the initial three treatment sessions are considered investigational and may be denied; do not submit requests for repeat treatments beyond the initial three-session course unless clear supporting evidence is provided.
- Initial course is three sessions; repeat procedures beyond those three are investigational
- Requests for additional procedures may trigger denial
Contraindications that may lead to denial
Do not perform bronchial thermoplasty during active respiratory infection, during asthma exacerbation, within 14 days of changing systemic corticosteroid dosing, in patients with implantable electronic devices, or in patients with known sensitivity to bronchoscopy medications; these contraindications may lead to denial.
- Active respiratory infection or asthma exacerbation
- Change in systemic corticosteroids within past 14 days
- Presence of pacemaker/internal defibrillator or other implantable electronic devices
- Known sensitivity to medications for bronchoscopy (lidocaine, atropine, benzodiazepines)
- Prior treatment of the same lung area
Coverage determinations depend on the member’s benefit plan
Coverage determinations and whether this service is a covered benefit are made based on the member’s health benefit plan; the existence of this medical policy does not guarantee the service is covered for a particular member.
- Medical policy does not constitute a description of benefits
- Member’s health benefit plan governs coverage, exclusions, limits, and preauthorization
Background and Rationale
Bronchial thermoplasty is performed with bronchoscopy to deliver radiofrequency energy to airway tissue with the intent to reduce airway smooth muscle mass and the muscle‑mediated component of bronchoconstriction. The Alair® system was approved by the FDA through the premarket approval process for use in adults with severe, persistent asthma not adequately controlled with inhaled corticosteroids and long‑acting beta‑agonists; the device heats targeted airway tissue (reported device descriptions indicate heating to approximately 65°C over a small airway segment) and is administered as a course of three outpatient procedures spaced about three weeks apart to achieve the intended physiologic effect.
Key Definitions
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