CurrentCentenePolicy CP MP.110

Clinical Policy: Bronchial Thermoplasty

Medical necessity and coverage criteria for bronchial thermoplasty (BT) as a treatment option for severe persistent asthma; applies to Centene plan reviewers and participating providers.

Policy Summary

PayerCentene

PolicyClinical Policy: Bronchial Thermoplasty

Policy CodePolicy CP MP.110

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain prior authorization and submit supporting clinical documentation consistent with Centene requirements before performing bronchial thermoplasty.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

31660-31661CPT codes cited for BT procedures

ERS/ATS, NICE, GINA, BTSGuideline sources referenced

low-qualityEvidence grade per Hayes

severalRCTs & follow-up

3Policy notices

Coverage Criteria & Policy Position

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Policy summary & guideline context

Covered / Not established summary and guideline context — policy position and how major society guidance frames use of bronchial thermoplasty (BT).

Policy stance: The long-term safety and effectiveness of bronchial thermoplasty has not been proven for severe asthma or any other indications.

Centene policy statement summarizing evidence uncertainty.

Guideline contexts: Major society guidance (ERS/ATS, NICE, GINA, BTS) restricts BT to highly selected adults, generally recommending performance only in the context of clinical trials, registries, or specialist centers with appropriate training and governance; additional research and long-term follow-up are needed.

Summarizes consensus recommendations and cautions from multiple professional bodies.

The policy notes an implicit exclusion based on the conclusion that the long-term safety and effectiveness of bronchial thermoplasty has not been proven for severe asthma or any other indications. This statement supports a not-established routine coverage stance and may result in denial of claims when clinical evidence or criteria are not met.

As a rationale for the not-established coverage position, the policy emphasizes that long-term safety and effectiveness have not been demonstrated. This uncertainty underlies the policy’s restrictive approach and justifies requiring compelling clinical justification or adherence to specific criteria before considering coverage.

Coverage determinations and benefit administration are governed by the Health Plan’s coverage documents and applicable legal and administrative policies; the clinical policy is a guide to medical necessity and does not constitute a contract or guarantee of payment and is subject to the plan’s terms, conditions, exclusions and limitations.

Provider Requirements & Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required before scheduling bronchial thermoplasty (BT). Obtain authorization per the Health Plan's procedures; services without prior authorization may be denied.

Prior authorization required for bronchial thermoplasty
Authorization must be obtained from the member's Health Plan before service

Note

Coverage Decisions Governed by Plan Documents

Coverage determinations and benefit administration for BT are governed by the member's plan documents. Providers should verify benefits, limitations, exclusions, and member eligibility in the evidence of coverage, certificate of coverage, policy, or contract; plan-level administrative rules apply.

Coverage is subject to all terms, conditions, exclusions and limitations of the member's coverage documents
State and federal requirements and Health Plan administrative policies also apply

Step Therapy

Prior Optimization and Specialist Evaluation Expected

Prior optimization of medical therapy is expected before considering BT. Patients should have persistent severe asthma despite optimal medical therapy and consideration of biologic treatments; assessment by an asthma specialist with BT expertise and treatment in an appropriately resourced center is recommended.

Confirm failure of optimal medical therapy and consideration/trial of biologic treatments when appropriate
Specialist assessment and treatment in a specialist center with appropriate resources (including ICU access) are recommended

Note

Provider Responsibilities & Compliance

Providers must follow Health Plan coverage rules, coding guidance, and applicable state and federal regulations. Exercise professional medical judgment and retain documentation that supports medical necessity.

Follow Health Plan-level administrative policies and procedures and applicable legal/regulatory requirements
Providers are expected to exercise professional medical judgment and are responsible for treatment decisions

Documentation Required

Coding & Documentation

Coding and documentation should reference relevant CPT codes and include clinical records to support medical necessity. Provide procedural and clinical documentation with claims to justify the service.

Reference CPT 31660 and 31661 where applicable
Supply clinical documentation demonstrating failure of optimal medical therapy, specialist evaluation, and rationale for BT

Denial Risk

Limited Long-Term Evidence

Long-term safety and effectiveness of bronchial thermoplasty have not been established. Providers should consider the limited evidence when evaluating BT and discuss risks, benefits, and alternatives with the patient.

Long-term safety and effectiveness not proven — factor into clinical decision-making and informed consent

Billing Rule

Provider Action & Administrative Compliance

Coverage determinations and administrative actions (including authorization, payment, and denials) are made in accordance with the Health Plan's processes. Providers should follow any additional provider-facing instructions from the Health Plan and submit requested information promptly.

Adhere to Health Plan submission requirements and respond to requests for additional information
Failure to follow plan processes may result in denial or nonpayment

OpenPayer

Clinical Policy: Bronchial Thermoplasty

Coverage Criteria & Policy Position

Procedure Coding

Provider Requirements & Authorization

Clinical Background

Definitions

31660	Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty one lobe.
31661	Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty (additional lobe).