ModifiedUnitedHealthcare Community PlanPolicy CSNCT0542.04

Bronchial Thermoplasty (for North Carolina Only)

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This North Carolina-only UnitedHealthcare Community Plan policy governs coverage of bronchial thermoplasty for asthma for providers and members receiving Medicaid managed care benefits in North Carolina.

Policy Summary

PayerUnitedHealthcare Community Plan

PolicyBronchial Thermoplasty (for North Carolina Only)

Policy CodePolicy CSNCT0542.04

Change TypeModified

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionVerify the North Carolina Medicaid Fee Schedule and contractual coverage requirements before billing CPT codes 31660 and 31661.

SourceLink

POLICY UPDATE CHANGES

The policy adds notation that CPT codes 31660 and 31661 are not listed on the North Carolina Medicaid Fee Schedule and therefore may not be covered by the North Carolina Medicaid Program.

The Clinical Evidence and References sections were updated to reflect current information.

NCApplicable state

Not coveredCoverage determination

UnprovenEvidence status

3 visits

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ModifiedUnitedHealthcare Community PlanPolicy CSNCT0542.04

Bronchial Thermoplasty (for North Carolina Only)

Customize your policy alerts

Sign up for UnitedHealthcare Policy CSNCT0542.04 alerts

Get alerted when Policy CSNCT0542.04 changes without checking for updates manually.

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Policy Summary

PayerUnitedHealthcare Community Plan

PolicyBronchial Thermoplasty (for North Carolina Only)

Policy CodePolicy CSNCT0542.04

Change TypeModified

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionVerify the North Carolina Medicaid Fee Schedule and contractual coverage requirements before billing CPT codes 31660 and 31661.

SourceLink

POLICY UPDATE CHANGES

The policy adds notation that CPT codes 31660 and 31661 are not listed on the North Carolina Medicaid Fee Schedule and therefore may not be covered by the North Carolina Medicaid Program.

The Clinical Evidence and References sections were updated to reflect current information.

NCApplicable state

Not coveredCoverage determination

UnprovenEvidence status

3 visits

Coverage Criteria

Unproven and not medically necessary

Bronchial thermoplasty is not covered under this policy.

Not medically necessary: Bronchial thermoplasty for treating asthma is unproven and not medically necessary due to insufficient evidence of efficacy.

This policy provides a noncoverage determination rather than member-specific clinical coverage criteria.

Bronchial thermoplasty is not medically necessary for treating asthma because evidence of efficacy is insufficient. The procedure is therefore considered unproven and is not covered under this policy.

Coding Information

Applicable CPT CodeCPT

31661

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

CPT Codes With North Carolina Medicaid Fee Schedule Notation — not on the State of North Carolina Medicaid Fee Schedule and therefore may not be covered by the State of North Carolina Medicaid ProgramCPT

31660
31661

FDA Product Codemixed

OOY	Product code for bronchial thermoplasty systems

Predicted FEV1

Predicted FEV1 threshold< 60% of predicted value

Relevant populationIndividuals with severe obstructive asthma

Pivotal study statusPatients with an FEV1 of < 60% predicted were excluded from the pivotal sham-controlled study

Provider Actions and Billing Alerts

Denial Risk

Coverage denial risk: insufficient evidence

Bronchial thermoplasty is denied because it is considered unproven and not medically necessary for treating asthma due to insufficient evidence of efficacy.

Billing Rule

Verify fee-schedule coverage before billing

Before billing, verify the North Carolina Medicaid Fee Schedule and applicable contractual coverage requirements. CPT codes 31660 and 31661 are not on the fee schedule and therefore may not be covered by the North Carolina Medicaid Program.

CPT 31660
CPT 31661

Clinical Background

Asthma is a heterogeneous disease generally characterized by chronic airway inflammation. Associated respiratory symptoms may include wheezing, shortness of breath, chest tightness, and cough.

Definitions and Procedure Description

Bronchial thermoplasty

Procedure typeMinimally invasive procedure

Energy usedControlled thermal radiofrequency energy

Delivery methodEnergy is delivered through a specialized catheter and bronchoscope to reduce airway smooth muscle mass and responsiveness

Bronchial thermoplasty procedure

Bronchoscope placementA standard flexible bronchoscope is introduced through the nose or mouth and into the lungs

Catheter placementA specialized catheter is advanced through the bronchoscope until it contacts the targeted airway wall

Thermal energy delivery