Anthem Blue Cross Connecticut SURG.00118 Bronchial Thermoplasty Form

This document addresses the use of bronchial thermoplasty as a treatment option for adults whose severe persistent asthma is not well-controlled with inhaled corticosteroids and long-acting beta-agonists.

Note: Please see the following documents for additional information related to the treatment of asthma:

• CG-REHAB-03 Pulmonary Rehabilitation

Position Statement

Investigational and Not Medically Necessary:

Bronchial thermoplasty is considered investigational and not medically necessary for the treatment of asthma and all other conditions.