ModifiedUnitedHealthcarePolicy CS014NE.P

Bronchial Thermoplasty (Nebraska Only)

This policy governs coverage and medical necessity determinations for bronchial thermoplasty (BT) in adults with asthma for UnitedHealthcare members in Nebraska.

Policy Summary

PayerUnitedHealthcare

PolicyBronchial Thermoplasty (Nebraska Only)

Policy CodePolicy CS014NE.P

Change TypeState-specific versionclinical and references updated

Effective DateNov 1, 2025

Next Review Date

Key ActionVerify member benefits and obtain any required plan-level prior authorization because BT is considered unproven and may be denied.

SourceLink

POLICY UPDATE CHANGES

Created state-specific policy version for the state of Nebraska and archived the previous policy version CS014.O.

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

Nebraska-onlyjurisdiction

3 outpatient visitstreatment visits

Insufficient evidencecoverage rationale

31660, 31661CPT codes listed

RCTs, registries, reviews

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Coverage Determination and Rationale

General coverage stance

Policy coverage determination

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

Policy applies only to Nebraska; BT is described as intended for adults with severe, persistent asthma not well controlled with medications but remains unproven per coverage rationale.

Guideline-based coverage context

Guideline-aligned considerations and contexts in which BT is discussed

Guideline positions supporting or restricting BT: Positions vary across professional bodies: CHEST (2014) concluded BT offers an important treatment option for adults with severe asthma who remain symptomatic despite maximal medical therapy; ERS/ATS (2014) and GINA (2025) recommend BT only within an independent registry or IRB-approved clinical study due to very low confidence in current effect estimates and uncertainty about long-term outcomes; NAEPPCC/NHLBI (2020) advises most adults with uncontrolled moderate-to-severe asthma should not undergo BT and suggests offering the procedure only in clinical trials or registries; NICE (2018) permits BT in specialist centers with appropriate clinical governance, consent, audit, and trained multidisciplinary teams for severe uncontrolled asthma despite optimal therapy.

Summarizes differing guideline recommendations and contexts (registry/clinical study vs specialist center use) and highlights patient selection and evidence limitations referenced by guidelines.

Bronchial thermoplasty (BT) is considered unproven and not medically necessary for the treatment of asthma. The policy’s coverage rationale states there is insufficient evidence of efficacy to support BT as a covered therapy for asthma for UnitedHealthcare members in Nebraska.

Pivotal trials and major guidelines identify patient groups that were excluded from randomized studies and emphasize caution. Notably, the pivotal sham‑controlled study excluded patients with chronic sinus disease, frequent chest infections, and those with FEV1 < 60% predicted. Guideline bodies (GINA and NAEPPCC/NHLBI) therefore recommend BT only in highly controlled contexts — for select adults after optimization and referral to specialty centers, and preferably within an independent registry or IRB‑approved clinical study.

The policy concludes that BT is unproven and not medically necessary because current evidence does not reliably demonstrate clinically meaningful efficacy. This insufficiency in the evidence base — including small numbers of trials, limited long‑term follow‑up, and trial limitations — underpins the exclusion of BT from coverage for asthma under this policy.

Major guideline analysis indicates that for most adults (age ≥18) with uncontrolled, moderate‑to‑severe persistent asthma, routine use of BT is not recommended. Guidance states that the benefits are small or uncertain, risks are moderate, and long‑term outcomes remain unclear; therefore BT should generally be reserved for use only within clinical trials or registries and not offered as standard treatment for most patients.

Procedure and Product Codes

Prior Authorization

Provider Actions and Documentation

The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or non‑covered health service. Benefit coverage for health services is determined by federal, state, or contractual requirements and applicable laws. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other policies and guidelines may apply.

Prior authorization and benefit verification: Prior authorization is required and providers must verify member benefits and plan terms before scheduling. Failure to obtain prior authorization or to confirm benefits may result in claim denial or patient financial responsibility.
Conflicts with plan terms: Services that conflict with a member’s specific plan benefits, exclusions, or network requirements are subject to noncoverage per the member’s contract. Providers should resolve any discrepancies with UnitedHealthcare prior to delivery of services.
Facility, clinician, and governance documentation: For claims and prior authorization, document the performing facility, attending clinician, and that appropriate institutional governance/credentialing supports the use of bronchial thermoplasty. Include operative/procedure notes, bronchoscopy report, device model/serial number when available, and evidence of multidisciplinary review if required by the plan.
Placement relative to medical therapy: Bronchial thermoplasty should be considered only after optimization of guideline-based medical therapy for severe persistent asthma (e.g., high-dose inhaled corticosteroids plus long-acting bronchodilators and other indicated controller therapies). Document prior medical management, response to therapy, and rationale for proceeding with bronchial thermoplasty.

Provider Requirements, Prior Authorization, and Documentation

Prior Authorization

Prior authorization follows 'not medically necessary' stance

This Nebraska-only medical policy states that bronchial thermoplasty (BT) is unproven and not medically necessary; prior authorization requirements, if any, should follow that coverage determination and referenced procedure codes.

Prior Authorization

Verify benefits and obtain authorization as required

Verify member benefits and obtain any required plan-level prior authorization before scheduling BT, because coverage is determined in the context of applicable member benefits and federal/state/contractual rules.

Note

Intended patient population and adjunctive role

BT is described as a treatment intended for adults with severe, persistent asthma that is not well controlled with medications and is used adjunctively to medical management.

Clinical Background and Evidence Overview

Asthma is a heterogeneous chronic inflammatory airway disease characterized by variable respiratory symptoms and expiratory airflow limitation. Bronchial thermoplasty is a minimally invasive bronchoscopic procedure that delivers controlled thermal radiofrequency energy to reduce airway smooth muscle mass; it is typically performed over three outpatient sessions spaced several weeks apart and is intended as an adjunctive intervention for adults with severe, persistent asthma not well controlled with medication, but its long‑term benefits and safety remain uncertain.

Key Definitions

Bronchial thermoplasty (BT) — definition and procedure characteristics

Procedure typeMinimally invasive bronchoscopic procedure delivered via a flexible bronchoscope using a specialized catheter to apply controlled thermal radiofrequency (RF) energy to airway smooth muscle (ASM).

Treatment intentReduce airway smooth muscle mass and responsiveness to decrease airway constriction and frequency/severity of asthma symptoms in adults with severe, persistent asthma not well controlled with medications.

Treatment scheduleAdministered over three outpatient visits about three weeks apart.

Technical detailsA catheter is advanced through the bronchoscope to contact targeted airway walls; controlled thermal RF energy is delivered to ASM while leaving surrounding tissue undamaged.

Typical procedural codingCPT 31660 (1 lobe) and 31661 (2 or more lobes) listed in the policy for reference.

Policy Summary

PayerUnitedHealthcare

PolicyBronchial Thermoplasty (Nebraska Only)

Policy CodePolicy CS014NE.P

Change TypeState-specific versionclinical and references updated

Effective DateNov 1, 2025

Next Review Date

Key ActionVerify member benefits and obtain any required plan-level prior authorization because BT is considered unproven and may be denied.

SourceLink

On This Page

Applicable 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

Device product codemixed

OOY	Bronchial thermoplasty system (FDA product code)

Step Therapy

Require optimization of medical therapy and specialty referral first

Guidelines recommend BT only after patients remain uncontrolled despite optimized medical therapy and typically within specialized contexts (registries or clinical studies) with referral to an asthma specialty center.

GINA: BT only as part of an independent IRB‑approved registry or clinical research study after optimized therapy.
NAEPPCC/NHLBI: offer BT only in trials or registries; most adults with uncontrolled moderate-to-severe asthma should not undergo BT.
NICE: perform BT only in specialist centers with governance and experienced clinicians for severe uncontrolled asthma despite optimal drug treatment.

Documentation Required

Perform BT only in specialist centers with documented governance and training

BT should be performed in multidisciplinary specialist centers, with documentation of clinician training/experience and standard clinical governance, consent, and audit processes when the procedure is considered.

Multidisciplinary team and specialist center with on-site access to intensive care (NICE).
Clinician training and experience managing severe asthma should be documented.

Denial Risk

Denial risk: BT unproven / not medically necessary

Bronchial thermoplasty is considered unproven and not medically necessary for treating asthma; claims for BT may be denied on that basis.

Denial Risk

Follow federal, state, and contractual plan terms

Coverage and authorization decisions must follow federal, state, or contractual plan requirements; in the event of conflict, those requirements govern and failure to check may lead to denial.

Severe, persistent asthma — definition and treatment context

DefinitionAsthma phenotype described as disease not well controlled with medications despite individualized, stepwise pharmacologic treatment.

PopulationAdults with severe, persistent asthma who remain symptomatic despite optimized medical therapy.

Management contextBT is described in the policy as intended for adults with severe, persistent asthma not well controlled with medications and as adjunctive to medical management.

Therapeutic approachStandard care is individualized stepwise pharmacologic treatment (per GINA), with BT considered only after medical optimization per guideline recommendations.

Bronchial thermoplasty (BT) — alternate definition and clinical intent from guidelines/literature

Guideline intent (ERS/ATS)Recommend BT for adults only within an independent systematic registry or IRB-approved clinical study because of very low-quality evidence and uncertain long-term consequences.

Guideline intent (GINA)BT may be a treatment option for select adults with uncontrolled asthma despite optimized therapy, but should only be performed as part of an independent IRB‑approved registry or clinical research study.

Guideline intent (NAEPPCC/NHLBI)Recommend most adults with uncontrolled moderate-to-severe persistent asthma should not undergo BT outside trials/registries due to small benefits, moderate risks, and uncertain long-term outcomes.

Guideline intent (NICE)Permit BT in specialist centers with multidisciplinary teams, governance, clinician training, and only for severe asthma uncontrolled despite optimal drug treatment; emphasize need for audit and long-term data collection.