Administrative processPrior authorization is required for bronchial thermoplasty.
Bronchial Thermoplasty may be covered if the criteria listed below are met.
Indications that are covered
- The ordering physician is a pulmonologist;
- Candidates should have a documented diagnosis of severe asthma and be 18 years or older;
- Asthma not well controlled on inhaled corticosteroids and long acting beta2-agonists as evidenced by:
- an Asthma Control Test (ACT) score 19 or less and/or
- Risk assessment of 1 or more;
- Candidates should
- be able to undergo bronchoscopy per hospital guidelines,
- have no pacemaker, internal defibrillator, or implantable electronic devices;
- have no known coagulopathy,
- have no known sensitivity to medications required to perform bronchoscopy;
- have not had previous treatment with the AlairR System in the area to be treated; and
- have no known unstable co-morbid conditions that would present a risk for bronchoscopy.
Bronchial thermoplasty is non-drug approach to treat patients with severe asthma. During bronchial thermoplasty, the Alair® catheter is introduced under direct visualization through the working channel of a flexible bronchoscope. Thermal energy heats the airway smooth muscle to inhibit smooth muscle contraction in all airways reachable by the bronchoscope. The procedure is done on an outpatient basis under conscious sedation, and three sessions are typically required.
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
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
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This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.