CurrentColorado Rocky Mountain Health PlansPolicy CS014.P

Bronchial Thermoplasty for Asthma

Defines Colorado Rocky Mountain Health Plans' medical policy on bronchial thermoplasty (BT) for treatment of asthma, including applicability by state, coverage rationale, clinical evidence summary, applicable procedure codes, and policy revision history.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyBronchial Thermoplasty for Asthma

Policy CodePolicy CS014.P

Change TypeRevisions (application, template updates)

Effective DateNov 1, 2025

Next Review Date

Key ActionDo not apply this Medical Policy in listed states; refer to the state-specific policy/guideline where noted.

POLICY UPDATE CHANGES

Effective 11/01/2025 added application language excluding Nebraska and North Carolina and updated Description of Services, Clinical Evidence, and References sections; archived prior version CS014.O.

04/01/2026 Template Update removed content/language pertaining to the state of Louisiana

Not coveredCoverage Position

2CPT Codes Referenced

2024Hayes update year

Coverage Summary

Defines Colorado Rocky Mountain Health Plans' medical policy on Bronchial Thermoplasty (BT) for treatment of asthma, including applicability by state, coverage rationale, clinical evidence summary, applicable procedure codes, and policy revision history. Effective date: November 1, 2025. Last review: April 1, 2026. This policy addresses BT for adults with severe, persistent asthma and outlines coverage rationale, evidence, and referenced procedure codes (CPT 31660, 31661).

Medical Necessity / Coverage Rationale

Coverage Rationale / Medical Necessity

Bronchial thermoplasty is considered:

Bronchial thermoplasty (BT) is unproven and not medically necessary for treating asthma due to insufficient evidence of efficacy.

Overall evidence is limited and of low to moderate quality, with studies showing modest benefits for quality of life and reductions in exacerbations but inconsistent and insufficient long-term efficacy and safety data. The Hayes Health Technology Assessment (2022; updated 2024) concluded that a low-quality body of evidence suggests BT may reduce exacerbations and healthcare utilization but is insufficient to define which patients benefit most and further research is needed.

Evidence:

- Systematic reviews and meta-analyses report modest QOL improvements and reduced exacerbations but note risk of bias and limited long-term randomized data (Cochrane, ECRI, Zhou et al.).

- Real-world and registry studies (PAS2, Hatch et al.) report reductions in exacerbations and health care use up to 5 years, but many lack control groups and have potential biases.

- Comparative and network meta-analysis (Fong et al.) suggests BT may be non-inferior to biologics for some outcomes, but no head-to-head RCTs exist.

Definitions:

- Bronchial Thermoplasty (BT): A bronchoscopic procedure delivering controlled thermal radiofrequency energy to airway smooth muscle to reduce muscle mass and responsiveness.

Not Medically Necessary / Not Covered

Coverage stance: Bronchial thermoplasty (BT) is considered unproven and not medically necessary for treating asthma due to insufficient evidence of efficacy. This policy cites the Hayes assessment and other systematic evaluations that identify a low-quality body of evidence, inconsistent long-term efficacy, and concerns about safety and generalizability. The policy therefore does not support BT as a covered, medically necessary treatment for asthma under the standard policy framework.

Provider Actions & Applicability

Documentation Required

State applicability

Do not apply this Medical Policy in the states listed; refer to the indicated state-specific policy or guideline where noted.

Idaho
Indiana
Kansas
Kentucky
Nebraska
New Jersey
New Mexico
North Carolina
Ohio
Pennsylvania
Tennessee

Documentation Required

Benefit determination guidance

Reference applicable federal, state, or contractual benefit plan requirements when making coverage determinations; those requirements govern if they conflict with this policy.

Background

Bronchial thermoplasty (BT) is a minimally invasive bronchoscopic procedure that uses controlled thermal radiofrequency energy to reduce airway smooth muscle mass and responsiveness. It is typically administered in three outpatient visits about three weeks apart. The procedure is intended for adults with severe, persistent asthma not well controlled with medications, and involves delivering thermal energy via a catheter passed through a flexible bronchoscope to targeted airway walls to reduce ASM while preserving surrounding tissue.

Overall Evidence Quality: Conclusive high-quality evidence is lacking; available studies are low to moderate quality and show modest benefits in quality of life and exacerbation reduction but inconsistent long-term efficacy and safety, indicating the need for more randomized controlled trials and longer follow-up.

Hayes Health Technology Assessment (2022; updated 2024): Hayes concluded that a low-quality body of evidence suggests BT may reduce asthma exacerbations, healthcare utilization, and medication use in some adults with severe asthma, but the evidence is insufficient to determine which patients benefit most and there remain concerns about study limitations, inconsistency of findings, and limited comparative data versus other treatments.

Revision History

11/01/2025Administrative and content updates