ModifiedUnitedHealthcarePolicy CS014.P

Bronchial Thermoplasty

Defines UnitedHealthcare's clinical policy stance on bronchial thermoplasty (BT) for treating asthma and the populations/states to which this document applies or excludes.

Policy Summary

PayerUnitedHealthcare

PolicyBronchial Thermoplasty

Policy CodePolicy CS014.P

Change TypeContent refresh and state applicability revisions

Effective DateNov 1, 2025

Next Review Date

Key ActionDo not submit claims for bronchial thermoplasty as it is considered unproven and not medically necessary under this policy; verify state-specific applicability and prior authorization requirements before requesting coverage.

SourceLink

POLICY UPDATE CHANGES

Removed content/language pertaining to the state of Louisiana.

Added language to indicate this Medical Policy does not apply to the states of Nebraska and North Carolina; refer to the state-specific policy versions.

Updated Description of Services, Clinical Evidence, and References sections to reflect the most current information.

Not medically necessaryCoverage stance

31660, 31661Referenced CPTs

AdultsPopulation

MultipleEvidence syntheses

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria and Rationale

Coverage Rationale

Not covered when:

Primary coverage stance: Bronchial thermoplasty is considered unproven and not medically necessary for treating asthma due to insufficient evidence of efficacy.

Policy-level determination

Coverage criteria (guideline-aligned)

Covered when ALL of the following are met (per guideline-informed policy statements):

Patient selection: Adult patients with severe asthma who remain symptomatic despite optimized or maximal medical therapy and referral to an asthma specialty center.adult; severe; optimized therapy

CHEST supports BT as a treatment option for adults with severe symptomatic asthma despite maximal medical treatment

Setting and oversight: Procedure performed in a specialist center by clinicians trained in bronchial thermoplasty with multidisciplinary team support and on-site access to intensive care, with arrangements for clinical governance, consent, and audit.specialist center; trained clinicians

NICE recommends BT only in specialist centers with governance and audit arrangements

Research/registry participation: Bronchial thermoplasty is performed only within an independent IRB-approved systematic registry or clinical study, or with mechanisms to collect long-term data.IRB-approved registry or clinical study preferred

ERS/ATS and GINA recommend BT only in research or registry contexts due to very low confidence in current evidence

Patient exclusions/considerations: Patients with chronic sinus disease, frequent chest infections, or FEV1 < 60% predicted (populations excluded from pivotal trials) should be carefully assessed and generally are not established beneficiaries of BT; consider trial eligibility and individual risk assessment.FEV1 >= 60% typically required in pivotal studies

GINA and trial reports note these exclusions; NAEPPCC/NHLBI advise caution due to limited benefits and uncertain long-term outcomes

This Medical Policy does not apply to the following states; refer to the state‑specific policy or guideline noted for local coverage determinations: Idaho, Indiana, Kansas, Kentucky, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Pennsylvania, and Tennessee. Providers should confirm and follow the applicable state‑specific policy when requesting authorization or submitting claims for bronchial thermoplasty in these jurisdictions.

Pivotal randomized controlled trials of bronchial thermoplasty excluded several patient groups relevant to clinical decision‑making. Notably, trials excluded patients with chronic sinus disease, those with frequent chest infections, and individuals with baseline pulmonary function of FEV1 < 60% predicted. These exclusions limit generalizability of trial results to these populations and should be considered when assessing candidate suitability.

UnitedHealthcare considers bronchial thermoplasty unproven and not medically necessary for the treatment of asthma due to insufficient evidence of efficacy. As a result, bronchial thermoplasty is not covered under this policy except as may be required by state‑specific rules or contractual provisions.

At a population level, guidelines and national guidance advise caution in the routine use of bronchial thermoplasty. For most adults (age ≥18) with uncontrolled, moderate‑to‑severe, persistent asthma, the NAEPPCC/NHLBI recommends that patients generally should not undergo bronchial thermoplasty because observed benefits are small, risks are moderate, and long‑term outcomes remain uncertain. Where considered, BT is typically reserved only after optimization of maximal medical therapy, shared decision‑making, and ideally within a clinical trial or registry setting as endorsed by guideline bodies (NAEPPCC/NHLBI, GINA).

Procedure and Device Coding

Referenced Procedure CPT CodesCPT

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.

Regulatory/Device codemixed

OOY	FDA product code for BT systems (informational)

Provider Requirements, Prior Authorization, and Billing Guidance

Prior Authorization

Prior Authorization Required

Prior authorization is required for bronchial thermoplasty (BT) procedures. Submit a prior authorization request before scheduling BT and include documentation that the patient meets medical necessity criteria per policy. Verify benefit coverage against federal, state, or contractual requirements as these may override this policy.

Prior authorization required for CPT 31660 and 31661
Check plan/federal/state/contractual requirements that may override policy before approval

Documentation Required

Coding and Procedural Documentation

Report the appropriate bronchial thermoplasty procedure code(s) on the claim and retain supporting clinical documentation with the medical record. If BT is performed, report CPT 31660 for treatment of one lobe or CPT 31661 for two or more lobes. Include documentation of indication, prior optimization of therapy, specialty center referral, procedural details, and post-procedure follow-up.

Clinical Background

Asthma is a heterogeneous chronic inflammatory airway disease managed with a stepwise medication approach emphasizing inhaled corticosteroids, bronchodilators, and adjunctive biologic therapies for severe disease. Bronchial thermoplasty (BT) is a minimally invasive bronchoscopic procedure that delivers controlled thermal radiofrequency energy to the airway wall over a series of outpatient sessions (typically three procedures spaced several weeks apart) with the objective of reducing airway smooth muscle mass and decreasing bronchoconstriction. BT is intended as an adjunctive option for select adults with severe, treatment‑refractory asthma, but current evidence and guideline guidance limit its use to specialized centers, research registries, or tightly controlled clinical programs.

Definitions and Key Terms

Definition of Bronchial Thermoplasty (BT)

DefinitionBronchial thermoplasty (BT) is a minimally invasive bronchoscopic procedure that delivers controlled thermal radiofrequency energy to reduce airway smooth muscle mass and responsiveness.

Intended populationIntended for adults with severe, persistent asthma not well controlled with medications.

Procedure deliveryPerformed using a standard flexible bronchoscope and a specialized catheter to contact airway walls and deliver RF energy while sparing surrounding tissue.

Treatment scheduleAdministered in three outpatient sessions approximately three weeks apart.

Mechanism goalAims to reduce airway constriction and frequency/severity of asthma symptoms by reducing airway smooth muscle mass.

BT Use in Research / Registry (ERS/ATS)