CurrentCentenePolicy CP.MP.110

Bronchial Thermoplasty (Clinical Policy)

Defines Centene's medical necessity position and coding implications for bronchial thermoplasty (BT) for severe asthma and who it affects (providers and members covered by Centene-affiliated health plans).

Policy Summary

PayerCentene

PolicyBronchial Thermoplasty (Clinical Policy)

Policy CodePolicy CP.MP.110

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain and document prior authorization reflecting CPT 31660 (one lobe) or 31661 (two or more lobes) when bronchial thermoplasty is performed and verify plan-specific prior authorization procedures.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2procedure codes listed

10+ yrslong-term follow-up

Very lowevidence grade

Manufacturer discontinuingsupply issue

2018copyright year

Coverage Criteria — Bronchial Thermoplasty

General coverage stance

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

Centene considers BT investigational/unsupported by sufficient evidence.

It is the policy of Centene-affiliated health plans that the long-term safety and effectiveness of bronchial thermoplasty has not been proven for severe asthma or any other indications; therefore, bronchial thermoplasty is not supported as a proven therapy.

Coverage and the administration of benefits for bronchial thermoplasty are governed by the member's coverage documents and applicable Health Plan administrative policies; all terms, conditions, exclusions and limitations of the coverage documents apply, and state Medicaid provisions take precedence where they conflict with this clinical policy.

Because long-term safety and effectiveness have not been proven, bronchial thermoplasty is considered investigational under this policy and may not be covered except as otherwise determined by the Health Plan.

Coding and Procedure Codes

Policy Summary

PayerCentene

PolicyBronchial Thermoplasty (Clinical Policy)

Policy CodePolicy CP.MP.110

Change TypeNo material changes

Effective Date

Next Review Date

SourceLink

On This Page

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Provider Actions, Authorization & Documentation

Prior Authorization

Prior Authorization and Documentation

Prior authorization requirements, coding and billing must be followed per the Health Plan's administrative policies and coverage documents. Providers should verify prior authorization requirements with the member's plan before scheduling bronchial thermoplasty. When prior authorization is required, documentation submitted must reflect the specific procedure(s) performed.

Verify prior authorization with the member's Health Plan before scheduling.
When bronchial thermoplasty is performed, document and submit the appropriate CPT code(s) (see coding guidance).
Prior authorization and coverage are governed by the applicable evidence of coverage, certificate of coverage, policy, contract and Health Plan administrative procedures.

Denial Risk

Long-term Safety and Effectiveness

The long-term safety and effectiveness of bronchial thermoplasty (BT) for severe asthma or other indications has not been established. Health plans affiliated with Centene consider BT investigational due to insufficient long-term evidence of benefit and safety.

BT is considered investigational for severe asthma and other indications.
Published guideline bodies recommend cautious, selective use and/or study-context treatment; additional long-term comparative data are needed.

Denial Risk

Denial Risk and Plan Limitations

Coverage decisions are subject to all terms, conditions, exclusions and limitations of the member's coverage documents and applicable Health Plan administrative policies. Providers should be aware that lack of required documentation, failure to obtain prior authorization when required, or performance of investigational procedures may result in claim denial.

Claims and coverage are subject to the member's specific plan documents and contract terms.
Failure to meet documentation or prior authorization requirements may lead to denial or nonpayment.

Billing Rule

Coding Guidance

Providers must reference current CPT guidance when submitting claims for bronchial thermoplasty and include procedure-specific documentation that supports the use of the submitted codes.

Reference the most current CPT manuals and professional coding guidance prior to claim submission.
Include clinical documentation that supports the medical necessity of the procedure and matches the CPT code(s) billed.

Documentation Required

Documentation Requirements

Document thoroughly in the medical record: indication for BT, prior optimization of medical therapy, specialist assessment, informed consent, details of the procedure (including lobes treated), peri-procedural care, and follow-up. Documentation must be available for review with prior authorization and claim submission.

Include evidence of optimization of medical therapy and consideration of alternative treatments (including biologics when applicable).
Document number of lobes treated and procedural details to support use of CPT 31660 or 31661.
Maintain records of prior authorization approval, informed consent, and post-procedure follow-up.

Step Therapy

Therapy Sequencing

Therapy sequencing: BT should be considered only in adults with severe uncontrolled asthma after optimization of medical therapy in accordance with guideline-recommended stepwise treatments and evaluation by an asthma specialist. BT is typically considered for patients who remain uncontrolled despite optimal therapy and consideration of biologic treatments or when biologics are unsuitable or have failed.

BT is intended for adults (age ≥18) with severe uncontrolled asthma after optimal medical management.
Selection and sequencing should follow guideline recommendations and specialist assessment; BT is not a first-line therapy.
There are no specific step-therapy requirements in this policy; follow the member's plan-level administrative requirements where applicable.

Definitions

Bronchial thermoplasty (BT) — definition

DefinitionBronchial thermoplasty (BT) — a bronchoscopic procedure that utilizes radiofrequency ablation to reduce airway smooth muscle cells.

PurposeIntended as a therapeutic option to reduce severe bronchoconstriction in severe persistent asthma.

Procedure modalityPerformed bronchoscopically using radiofrequency energy to ablate airway smooth muscle.

Clinical aimReduce airway smooth muscle mass to decrease bronchoconstriction and asthma symptoms in selected patients.

Clinical policy — definition

DefinitionClinical policy — a guide to medical necessity used to assist in making coverage decisions and administering benefits; it is not a contract or guarantee regarding payment or results.

ScopeProvides standards based on medical practice, peer‑reviewed literature, regulatory status, evidence‑based guidelines, and expert views to inform coverage decisions.

LimitationsDoes not constitute medical advice or dictate how providers should practice; providers remain responsible for medical judgment and treatment decisions.

Legal contextCoverage and administration of benefits are subject to terms, conditions, exclusions, limitations of coverage documents and applicable law/regulation; state Medicaid provisions prevail when in conflict.

OpenPayer

Bronchial Thermoplasty (Clinical Policy)

Coverage Criteria — Bronchial Thermoplasty

Coding and Procedure Codes

Provider Actions, Authorization & Documentation

Background — Bronchial Thermoplasty

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, two or more lobes