CurrentColorado Rocky Mountain Health PlansPolicy CS014.P

Bronchial Thermoplasty – Community Plan Medical Policy

Defines the medical policy for bronchial thermoplasty (BT) as a treatment for asthma, including applicability by state, coverage rationale, clinical evidence summaries, applicable CPT procedure codes, and policy revision history for Colorado Rocky Mountain Health Plans (UnitedHealthcare Medical Policy CS014.P).

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyBronchial Thermoplasty – Community Plan Medical Policy

Policy CodePolicy CS014.P

Change TypeTemplate/Application updates

Effective DateNov 1, 2025

Next Review DateN/A

Key ActionWhen deciding coverage, reference federal, state or contractual benefit plan requirements as they may differ; in event of conflict those requirements govern.

SourceLink

POLICY UPDATE CHANGES

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

11/01/2025 Application updated to add Nebraska and North Carolina exceptions and updated Description of Services, Clinical Evidence, and References.

1Policy stance (Not Medically Necessary)

2CPT codes listed

11States with state-specific policies/exceptions listed

Coverage Summary

Policy Number: CS014.P. Effective Date: November 1, 2025; Last Review: April 1, 2026. Bronchial thermoplasty (BT) is considered unproven and not medically necessary for treating asthma due to insufficient evidence of efficacy.

Key Policy Summary

Policy stance (Coverage Rationale)Not Medically Necessary (Bronchial thermoplasty is unproven and not medically necessary for treating asthma due to insufficient evidence of efficacy).

CPT codes listed (count)2

States with exceptions (count)11

Effective dateNovember 1, 2025

Last reviewApril 1, 2026

Policy numberCS014.P

Application / Geographic Exceptions

This Medical Policy does not apply to the following states; refer to state-specific policy/guideline:

Idaho: refer to Bronchial Thermoplasty (for Idaho Only)

Indiana: Policy/Guideline = None

Kansas: refer to Bronchial Thermoplasty (for Kansas Only)

Kentucky: refer to Bronchial Thermoplasty (for Kentucky Only)

Nebraska: refer to Bronchial Thermoplasty (for Nebraska Only)

New Jersey: refer to Bronchial Thermoplasty (for New Jersey Only)

New Mexico: refer to Bronchial Thermoplasty (for New Mexico Only)

North Carolina: refer to Bronchial Thermoplasty (for North Carolina Only)

Ohio: refer to Bronchial Thermoplasty (for Ohio Only)

Pennsylvania: refer to Bronchial Thermoplasty (for Pennsylvania Only)

Tennessee: refer to Bronchial Thermoplasty (for Tennessee Only)

Documentation Required

State-specific policy exceptions

Refer to any listed state-specific policy or guideline for coverage in those states. If the state-specific policy/contract differs from this Medical Policy, the state or contractual requirement governs.

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

Provider Actions

Documentation Required

Refer to federal/state/contractual requirements

When deciding coverage, reference federal, state, or contractual benefit plan requirements as they may differ; in the event of conflict those requirements govern.

Documentation Required

Use of medical policy as guidance

This Medical Policy provides assistance in interpreting UnitedHealthcare standard benefit plans and is informational — providers should confirm plan-specific coverage and plan terms.

This Medical Policy is provided for informational purposes to assist in interpreting UnitedHealthcare standard benefit plans; providers should confirm federal, state, or plan-specific coverage and plan terms, as this policy may not apply in certain states or under specific contractual requirements.

Background & Clinical Evidence

Bronchial thermoplasty is a minimally invasive procedure that uses controlled thermal radiofrequency (RF) energy delivered via a bronchoscope to reduce airway smooth muscle mass and responsiveness. It is intended for adults with severe, persistent asthma not well controlled with medications and is administered over three outpatient visits approximately three weeks apart; during each treatment a catheter is advanced through a flexible bronchoscope to contact targeted airway walls and deliver controlled thermal RF energy while leaving surrounding tissue undamaged.

Source	Summary
Hayes health technology assessment (2022; updated 2024)	Concluded low-quality evidence suggests BT may reduce exacerbations and healthcare utilization but evidence is limited and comparative data to alternatives are insufficient.
ECRI assessment (2020)	Found benefits modest and of unclear clinical significance; AEs more common during treatment and evidence inconclusive.
Systematic reviews and trials (AIR, AIR2, RISA, PAS2, etc.)	Mixed evidence: some improvement in quality of life and exacerbations but no consistent lung function benefit; risk of adverse events and limited long-term/sham-controlled data.

Definition

Definition (Bronchial Thermoplasty - BT)A minimally invasive procedure using controlled thermal radiofrequency energy delivered via bronchoscope to reduce airway smooth muscle mass to reduce airway constriction.

Revision History

04/01/2026revised (Administrative/template update)Latest

Template Update removed content/language pertaining to the state of Louisiana. Administrative/template update; removed Louisiana-specific language.

11/01/2025revised (Application updated)

Application updated to add Nebraska and North Carolina exceptions and updated Description of Services, Clinical Evidence, and References; archived previous policy version CS014.O.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyBronchial Thermoplasty – Community Plan Medical Policy

Policy CodePolicy CS014.P

Change TypeTemplate/Application updates

Effective DateNov 1, 2025

Next Review DateN/A

Key ActionWhen deciding coverage, reference federal, state or contractual benefit plan requirements as they may differ; in event of conflict those requirements govern.

SourceLink

On This Page

31660	Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe
31661	Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes

OpenPayer

Bronchial Thermoplasty – Community Plan Medical Policy

Coverage Summary

Medical Necessity / Coverage Rationale

Application / Geographic Exceptions

Coding

Provider Actions

Background & Clinical Evidence

Revision History