Bronchial Thermoplasty Form
Procedure is not covered
Medical Policy
Subject:
Bronchial Thermoplasty
Policy Number: MP-0190
Applies To: All Lines
Effective Date: 9/2/17
Revised: October 2023
Document Page Length: 2
Medical Policy Statement: Bronchial Thermoplasty (BT) is not covered under any
HFHP benefit plan. BT is considered not medically necessary for the treatment of
asthma as there is insufficient evidence concerning the extent of benefit and long-term
safety and efficacy of this treatment.
Description: Bronchial thermoplasty is a treatment for asthma that delivers
controlled thermal energy to the airway wall during a series of bronchoscopy procedures
to decrease smooth muscle mass to improve asthma control. The long term safety and
efficacy of this procedure is unproven.
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Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.