ModifiedUnitedHealthcarePolicy CSO1ANJ.N

Bronchial Thermoplasty (for New Jersey Only)

This UnitedHealthcare New Jersey medical policy governs coverage of bronchial thermoplasty for treating asthma in New Jersey members and describes the payer's stance and related coding. It applies to providers requesting authorization or billing for the procedure in New Jersey.

Policy Summary

PayerUnitedHealthcare

PolicyBronchial Thermoplasty (for New Jersey Only)

Policy CodePolicy CSO1ANJ.N

Change TypeSupporting information updated

Effective DateNov 1, 2024

Next Review Date

Key ActionConfirm prior authorization and submit documentation demonstrating severe, uncontrolled asthma after optimization of medical therapy and specialist assessment; include referenced procedure codes for claims.

SourceLink

POLICY UPDATE CHANGES

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

3 visitsBT sessions

31660, 31661Reference codes

insufficient evidencePolicy conclusion

1,845Evidence patient count

20.4%

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30-day safety issues

3-yearReported durable reductions

Coverage Determination

Coverage stance

Covered when ALL of the following are met

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

Policy conclusion: not covered except as allowed by contract or state-specific requirements

Guideline-aligned coverage considerations

Coverage considerations align with major guideline positions which generally limit BT to adults with severe, uncontrolled asthma after optimization and often recommend registry/IRB oversight or specialist center setting.

Guideline-aligned patient selection: Adults (≥18 years) with severe asthma that remains uncontrolled despite optimized medical therapy and confirmed adherence, with asthma diagnosis verified by an asthma specialist experienced in BT

Sources: BTS, ERS/ATS, GINA, NAEPPCC/NHLBI, NICE

Context of performance: BT performed in a specialist centre with multidisciplinary support and on-site access to intensive care OR as part of an independent IRB‑approved systematic registry or clinical study

BTS and NICE recommend specialist centres; ERS/ATS and GINA recommend registry/IRB oversight

Consideration of other therapies: Patients should have had optimization of medical therapy and consideration of biologic therapies; BT may be considered when biologics are unsuitable or have failed, or when other options are exhausted

BTS and NAEPPCC/NHLBI note BT as an option after consideration/trial of biologics or in select patients after shared decision making

Bronchial thermoplasty (BT) is not covered and is considered not medically necessary for the treatment of asthma due to insufficient evidence of efficacy.

Most individuals ages 18 years and older with uncontrolled, moderate-to-severe, persistent asthma should not undergo bronchial thermoplasty because the benefits are small, the risks are moderate, and long-term outcomes remain uncertain; when considered, BT is best offered only after thorough shared decision-making and ideally within a clinical trial or registry setting.

Bronchial thermoplasty is unproven and not medically necessary for treating asthma based on the current body of evidence demonstrating limited and uncertain clinical benefit.

Routine use of bronchial thermoplasty outside of experienced specialist centers, systematic registries, or Institutional Review Board–approved clinical studies is discouraged for most patients with uncontrolled moderate-to-severe persistent asthma because available trials have limitations and long-term safety and effectiveness data are limited.

Provider Requirements and Prior Authorization

Prior Authorization

Prior authorization — procedure codes (reference)

CPT codes 31660 (bronchoscopy with bronchial thermoplasty, lobe) and 31661 (bronchoscopy with bronchial thermoplasty, 2 or more lobes) are listed for reference; listing does not imply coverage and inclusion of the codes does not guarantee reimbursement. Because the policy concludes BT is unproven and not medically necessary, prior authorization requests using these codes would likely be denied unless contract or state requirements override this stance.

31660 — Bronchoscopy, rigid or flexible; with bronchial thermoplasty, lobe
31661 — Bronchoscopy, rigid or flexible; with bronchial thermoplasty, 2 or more lobes

Prior Authorization

Prior authorization requirement — guideline-aligned patient selection

Prior authorization must confirm the patient meets guideline-aligned selection: an adult (≥18 years) with severe asthma that remains uncontrolled despite optimized medical therapy and specialist assessment, and that treatment will occur in an appropriate specialist center or registry/IRB-approved study as recommended by major guideline bodies.

Adults only (age ≥18) with severe, uncontrolled asthma despite optimized therapy

Procedure and Device Codes

Applicable procedure codes (reference)CPT

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

Informational device codemixed

OOY	FDA product code referenced for BT systems

Clinical Background

Asthma is a heterogeneous, chronic inflammatory airway disease characterized by variable respiratory symptoms (for example, wheeze, shortness of breath, chest tightness, and cough) and variable airflow limitation. Usual maintenance therapy includes inhaled corticosteroids and combination inhaled corticosteroid/long-acting beta-agonists, with additional options such as long-acting muscarinic antagonists, biologic therapies, and systemic corticosteroids for severe disease; bronchial thermoplasty is a catheter-based radiofrequency procedure delivered bronchoscopically in a series of outpatient sessions aiming to reduce airway smooth muscle mass and responsiveness.

Definitions and Key Terms

inv-18: Bronchial thermoplasty (BT) — definition and procedural overview

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

Treatment intentIntended for adults with severe, persistent asthma that is not well controlled with conventional medications.

Procedure deliveryPerformed using a flexible bronchoscope and a specialized catheter that contacts targeted airway walls to deliver controlled thermal RF energy while sparing surrounding tissue.

Treatment scheduleAdministered over three outpatient visits approximately three weeks apart.

Expected physiologic effectAims to reduce airway smooth muscle mass and airway constriction, potentially decreasing severity and frequency of asthma symptoms.

Policy Summary

PayerUnitedHealthcare

PolicyBronchial Thermoplasty (for New Jersey Only)

Policy CodePolicy CSO1ANJ.N

Change TypeSupporting information updated

Effective DateNov 1, 2024

Next Review Date

SourceLink

On This Page

Assessment by an asthma specialist with BT expertise

Treatment in a specialist center or within an IRB-approved registry/clinical study

Note

Background on medical therapy — standard stepwise treatments

Document the stepwise asthma pharmacologic approach before considering BT: maintenance therapy with inhaled corticosteroids (ICS), ICS combined with long-acting beta-agonists (LABA), and add-on options including long-acting muscarinic antagonists, biologics, and systemic corticosteroids; reliever strategies (e.g., ICS-formoterol or SABA) are also standard.

Maintenance: ICS, ICS+LABA, leukotriene receptor antagonists
Add-on: LAMA, biologic therapies, systemic corticosteroids
Relievers: low-dose ICS-formoterol or SABA

Step Therapy

Prior therapeutic optimization required before BT

Authorization should verify medical optimization has occurred and that BT is being considered only after optimization of medical therapy and consideration or trial of biologic therapies when appropriate, consistent with guideline recommendations.

Confirm optimal medical therapy and adherence prior to BT
Document consideration of biologic therapies and trials when applicable

Billing Rule

Coding and documentation note — include referenced procedure codes

Use CPT 31660 and 31661 on authorization requests and claims, and include supporting clinical documentation; listing of codes is for reference only and does not imply coverage or payment.

Include the applicable CPT (31660, 31661) on submissions
Attach clinical records that support the medical necessity rationale

Documentation Required

Required clinical documentation to support authorization

Provide clinical documentation that confirms the asthma diagnosis, documents uncontrolled status despite optimized therapy and adherence, records specialist assessment, and details therapies tried (including biologics if applicable) or enrollment in a registry/IRB-approved study.

Confirmed diagnosis of asthma and evidence symptoms are due to asthma
Objective and clinical evidence of uncontrolled asthma despite optimal therapy and adherence
Assessment and recommendation from an asthma specialist with BT expertise
Therapies tried, including biologic trials or reason biologics were unsuitable
If applicable, documentation of enrollment in an independent registry or IRB-approved study

Denial Risk

Denial risk — not medically necessary without strong justification

Because the policy states bronchial thermoplasty is unproven and not medically necessary for treating asthma, requests lacking strong guideline-aligned justification or registry/IRB context are at risk of denial as not medically necessary.

BT is considered unproven and not medically necessary due to insufficient evidence of efficacy
Expect denial when documentation does not demonstrate guideline-concordant indication, specialist assessment, or registry/IRB oversight

Note

Center and provider qualifications — specialist setting and oversight expected

Expect requests to be scrutinized if procedures are proposed outside specialist centers or without assessment by an asthma specialist experienced in BT, multidisciplinary support, or registry/IRB oversight; lack of these expectations may prompt coverage denial or requests for additional documentation.

Treatment ideally performed in a specialist center with appropriate resources and ICU access
Assessment by an asthma specialist with BT expertise is expected
ERS/ATS and GINA recommend BT only in the context of an independent registry or IRB-approved study

inv-19: Severe, uncontrolled asthma despite optimal medical therapy and specialist assessment — definition of severe asthma context

PopulationAdults (aged 18 years and over) with severe asthma.

Control statusAsthma remains poorly controlled or uncontrolled despite optimal medical therapy and adherence.

Specialist assessmentAssessment and confirmation by an asthma specialist with expertise in bronchial thermoplasty is recommended before treatment.

Consideration of other therapiesPatients should have had consideration of biologic therapies and, where appropriate, be unsuitable for or have failed a trial of biologics before BT is considered.

Setting recommendationBT should be performed in or referral made to a specialty/specialist center; BTS and GINA recommend specialist center assessment and resources.

inv-20: Procedure performed as part of an independent systematic registry or IRB-approved clinical study — registry/IRB context

Registry/Study requirement (ERS/ATS)ERS/ATS recommends BT only in the context of an independent systematic registry or a clinical study with IRB approval (strong recommendation; very low quality evidence).

GINA positionGINA states BT should only be performed as part of an independent IRB-approved systematic registry or clinical research study; evidence is limited and for selected patients.

Purpose of registry/IRB oversightRegistry or IRB-approved study participation is intended to collect systematic data on efficacy, safety, phenotypes of responders, and long-term outcomes.

Need for further researchGuidelines note that further research is needed to define effects on objective outcomes (exacerbation rates, lung function) and long-term safety.