ModifiedUnitedHealthcarePolicy CS014TN.O

Bronchial Thermoplasty (for Tennessee Only)

This policy governs coverage and medical necessity determination for bronchial thermoplasty (BT) as a treatment for adults with severe persistent asthma for Tennessee Medicaid and CoverKids.

Policy Summary

PayerUnitedHealthcare

PolicyBronchial Thermoplasty (for Tennessee Only)

Policy CodePolicy CS014TN.O

Change TypeRevision — clinical evidence and references updated

Effective DateNov 1, 2025

Next Review Date

Key ActionObtain medical necessity prior authorization confirming BT is for severe asthma uncontrolled despite optimized therapy and document specialist center care and prior treatments.

SourceLink

POLICY UPDATE CHANGES

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

not medically necessarycoverage stance in policy

31660,31661procedure codes listed

Tennessee Medicaid & CoverKidsapplication population

multiple reviewsevidence summaries referenced

recommend registry/studyguideline uncertainty

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11/01/2025revision effective

Coverage Determination for Bronchial Thermoplasty

Coverage stance

Policy conclusion

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

Policy applies to Tennessee Medicaid and CoverKids.

Guideline-based considerations

Guideline positions summarized (not exhaustive policy criteria):

Guideline consensus for BT use: BT considered only for adults with severe asthma uncontrolled despite optimized therapy and referral to specialty careadult; severe uncontrolled asthma

Supported by CHEST, GINA, NAEPPCC/NHLBI, NICE; ERS/ATS recommends only in registries or clinical studies

Coverage determination: Bronchial thermoplasty (BT) is not covered and is considered not medically necessary for the treatment of asthma because the available evidence is insufficient to establish its efficacy.

Evidence gap for low lung function populations: pivotal sham‑controlled trials excluded patients with FEV1 < 60% predicted, leaving a lack of direct evidence on safety and effectiveness of BT for individuals with substantially reduced baseline lung function.

Conclusion restated: given the limited and inconclusive trial data, BT remains unproven and is therefore classified as not medically necessary for treating asthma in this policy.

Guideline nuance: major guideline panels note that for most adults with uncontrolled, moderate‑to‑severe persistent asthma, BT should generally not be performed because benefits are small, risks are moderate, and long‑term outcomes are uncertain; when considered, BT is recommended only within a clinical trial or registry setting after shared decision‑making.

Procedure and Regulatory Codes

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.

FDA product code (informational)mixed

OOY	FDA product code for BT systems (informational)

Provider Requirements, Prior Authorization, and Documentation

Prior Authorization

Prior Authorization Required

Prior authorization is required for bronchial thermoplasty (BT) for Tennessee Medicaid and CoverKids. Submit a prior authorization request before scheduling BT procedures; claims for BT without an approved prior authorization may be denied. Ensure clinical documentation clearly supports the medical necessity review.

Affected CPT codes: 31660, 31661
Payer programs: Tennessee Medicaid and CoverKids
Prior authorization required before service

Prior Authorization

Prior Authorization for Severe Uncontrolled Asthma

For members with severe, uncontrolled asthma, prior authorization must document that asthma is severe and remains uncontrolled despite optimized therapy. Provide objective and recent clinical data demonstrating severe uncontrolled status and prior treatment history to support necessity for BT evaluation.

Document evidence of severe uncontrolled asthma (e.g., frequent exacerbations, ED visits, hospitalizations, oral corticosteroid bursts, symptom burden)

Clinical Background and Context

Asthma is a heterogeneous chronic airway inflammatory disease characterized by variable respiratory symptoms (for example, wheeze, dyspnea, chest tightness, and cough) and variable expiratory airflow limitation. Management is personalized and stepwise, using inhaled and systemic medications to control symptoms and reduce exacerbation risk.

Key Definitions

inv-18: Bronchial thermoplasty (BT) — definition of the procedure and its mechanism

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

Mechanism of actionRF energy is applied to targeted airway walls through a catheter passed via a flexible bronchoscope to thermally ablate ASM while sparing surrounding tissue, with the goal of reducing airway constriction and frequency/severity of asthma symptoms.

Treatment deliveryBT is typically delivered in three outpatient visits about three weeks apart, each session treating targeted lobes of the lung.

Procedure componentsProcedure involves introduction of a standard flexible bronchoscope through the nose or mouth, advancement of a specialized catheter to contact the airway wall, and controlled delivery of thermal RF energy to the ASM.

Intended populationIntended for adults with severe, persistent asthma that is not well controlled with medications (contextual clinical use; policy considers BT unproven).

Policy Summary

PayerUnitedHealthcare

PolicyBronchial Thermoplasty (for Tennessee Only)

Policy CodePolicy CS014TN.O

Change TypeRevision — clinical evidence and references updated

Effective DateNov 1, 2025

Next Review Date

Key ActionObtain medical necessity prior authorization confirming BT is for severe asthma uncontrolled despite optimized therapy and document specialist center care and prior treatments.

SourceLink

On This Page

Provide recent objective measures (e.g., spirometry, FEV1, bronchodilator response) and dates

Include medication history showing trials of and adherence to high-dose inhaled corticosteroids plus additional controllers

Note

Clinical Treatment Context

BT should be considered only within the context of stepwise asthma management. Include documentation that guideline-based, stepwise treatment was followed and that BT is being considered as an option after failure of optimized medical therapy and specialty referral.

State where BT fits in the patient's stepwise management plan
Confirm referral to or management by an asthma specialty center

Step Therapy

Optimization of Medical Therapy Prior to BT

Prior to BT, documentation must show optimization of medical therapy including trials of high-dose inhaled corticosteroids plus at least one additional controller, assessment of adherence and inhaler technique, and consideration of biologic therapies when indicated. Referral to an asthma specialist and discussion of alternative advanced therapies should be documented.

Document trials of optimized therapy (high-dose ICS + controller, leukotriene modifiers, LABA, etc.) and dates
Document assessment of adherence and inhaler technique
Document consideration and trial or ineligibility for biologic therapy when appropriate
Include specialist consultation notes supporting that medical therapy was optimized

Documentation Required

Procedure Coding and Documentation

Claims must include proper procedure coding and supporting documentation sufficient to justify CPT 31660 or 31661. Clinical notes should describe the procedure, targeted lobes, and that bronchoscopic guidance was used. Failure to supply procedure details and supporting clinical indications may lead to denial.

Use CPT 31660 for BT, 1 lobe; CPT 31661 for BT, 2 or more lobes
Include operative/procedure report describing bronchoscopy, lobes treated, device/technique, and immediate complications
Supply pre-procedure clinical justification and prior authorization approval identifier with the claim

inv-19: Specialist center — definition as a multidisciplinary center with on-site ICU access and trained clinicians

DefinitionA specialist center is a multidisciplinary facility with expertise in severe asthma care where BT is performed by clinicians trained in the procedure and experienced in managing severe asthma.

On-site critical careThe center must have on-site access to intensive care services (ICU) to manage potential serious complications, per guideline recommendations.

Multidisciplinary teamCare should be delivered by a multidisciplinary team and include standard arrangements for clinical governance, consent, and audit when BT is offered.

Research/registry contextGuidelines (e.g., ERS/ATS, GINA) recommend BT be performed only within independent IRB‑approved registries or clinical studies or at experienced specialist centers due to limited evidence and uncertain long-term outcomes.