31661
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
4.14
Facility
$178.69
Non-Facility
$178.69
Documentation Required
- No explicit documentation requirements are specified in this Medical Policy.
- Policy requires reference to the member specific benefit plan document when deciding coverage: "When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan. In the event of a conflict, the member specific benefit plan document governs." (Instructions for Use)
- In the absence of Medicare NCD/LCD or other Medicare coverage guidance, a Medicare Advantage Organization may create its own coverage determinations using objective evidence-based rationale. (Instructions for Use)
- If pursued, clinical trial or registry use should follow IRB-approved protocols and registry documentation per guideline recommendations (ERS/ATS, GINA, NAEPPCC/NHLBI statements referenced in policy).
Key Coverage Criteria
- None — "Bronchial thermoplasty is unproven and not medically necessary for treating asthma due to insufficient evidence of efficacy." (Coverage Rationale)
- Bronchial thermoplasty (BT) for treatment of severe asthma to reduce exacerbation rates and/or emergency department visits or hospitalizations (studies report persistent benefit at five-year follow-up).
- Candidates for BT should be selected via a multidisciplinary team at specialized asthma centers with high volumes of severe asthma patients and demonstrated expertise in interventional pulmonology.
- Adults with severe asthma being considered for bronchial thermoplasty (BT) — generally only within a clinical trial or independent systematic registry (per 2014 ERS/ATS statement).
- Adults with severe asthma may be considered for BT when 'standard arrangements' are in place (per NICE guidance).
- Bronchial thermoplasty for patients with severe asthma when considered as a treatment option.
5 Active Policies
AMBETTER-CP.MP.110 — Bronchial Thermoplasty
UMR-POL-UMR-bronchial-thermoplasty — Bronchial Thermoplasty
SUREST-POL-SUREST-bronchial-thermoplasty — Bronchial Thermoplasty
UHC-POL-bronchial-thermoplasty — Bronchial Thermoplasty
ANTHEM-SURG.00118 — SURG.00118 Bronchial Thermoplasty
Related Codes
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