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    v1.0.31
    OpenPayerPolicy UpdatesPulmonologyUnitedHealthcare Thermoplasty Coverage | OpenPayer
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    CurrentUnitedHealthcarePolicy CS014NJ.P

    Bronchial Thermoplasty (for New Jersey Only)

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    This policy governs coverage of bronchial thermoplasty for asthma under the UnitedHealthcare Community Plan in New Jersey. Bronchial thermoplasty is considered unproven and not medically necessary because evidence is insufficient to establish efficacy.

    Policy Summary
    PayerUnitedHealthcare
    PolicyBronchial Thermoplasty (for New Jersey Only)
    Policy CodePolicy CS014NJ.P
    Change TypeSupporting information only
    Effective DateOctober 1, 2026
    Next Review DateNot specified
    Key ActionDo not expect coverage for bronchial thermoplasty because it is classified as unproven and not medically necessary for treating asthma.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    NJApplicable state
    Not medically necessaryCoverage stance
    3 visitsTypical treatment schedule
    573Systematic review participants

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    IRR 2.95
    Severe exacerbation risk

    Bronchial Thermoplasty Coverage Determination

    Unproven and not medically necessary

    Bronchial thermoplasty is not covered as medically necessary under this policy.

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

    No positive coverage criteria are provided.

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

    Coding Information

    CPT CodeCPT
    31661Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes
    FDA Product CodeFDA
    OOYFDA product code for bronchial thermoplasty systems

    Provider and Billing Implications

    Denial Risk

    Bronchial thermoplasty is subject to denial

    Bronchial thermoplasty for treating asthma is subject to denial because this policy classifies it as unproven and not medically necessary due to insufficient evidence of efficacy.

    Asthma and Bronchial Thermoplasty

    Asthma is a heterogeneous disease characterized by chronic airway inflammation and variable expiratory airflow limitation. Symptoms may include wheezing, shortness of breath, chest tightness, and cough.

    Key Term

    Bronchial thermoplasty
    Procedure typeMinimally invasive procedure
    Intended useTreating adults with severe, persistent asthma that is not well controlled with medications
    Energy deliveredControlled thermal radiofrequency energy
    Delivery methodA specialized catheter advanced through a flexible bronchoscope to the targeted airway wall
    Intended effectReduce airway smooth muscle mass and responsiveness, which may reduce airway constriction and asthma symptom severity and frequency
    Policy Summary
    PayerUnitedHealthcare
    PolicyBronchial Thermoplasty (for New Jersey Only)
    Policy CodePolicy CS014NJ.P
    Change TypeSupporting information only
    Effective DateOctober 1, 2026
    Next Review DateNot specified
    Key ActionDo not expect coverage for bronchial thermoplasty because it is classified as unproven and not medically necessary for treating asthma.
    SourceLink
    On This Page
    Bronchial Thermoplasty Coverage DeterminationCoding InformationProvider and Billing ImplicationsAsthma and Bronchial ThermoplastyKey Term