Humana Commercial Clinical Policy

Humana Bronchial Thermoplasty Form

Effective Date

07/27/2023

Last Reviewed

NA

Original Document

  Reference



Description

Bronchial thermoplasty has been suggested as a treatment for severe asthma in individuals 18 years of age or older whose asthma is not well controlled with standard medical therapy (eg, inhaled corticosteroids and long-acting beta- agonists). This treatment was designed to reduce, debulk or partially eliminate excess smooth muscle tissue in the central and peripheral airways to decrease the number of severe asthma attacks.

One example of a US Food & Drug Administration (FDA)-approved bronchial thermoplasty system is the Alair Bronchial Thermoplasty System.

During the outpatient procedure, a flexible bronchoscope is inserted into the lungs via the individual’s mouth or nose. The thermoplasty catheter is then introduced through a channel within the bronchoscope. Once in place, the catheter tip expands allowing four electrodes to make contact with the airway wall. Using a radiofrequency controller, the physician delivers controlled thermal energy to heat smooth muscle in the airway wall to approximately 150 degrees Fahrenheit (enough to thin smooth muscle tissue mass without causing tissue damage or scarring). Three sessions are required approximately 3 weeks apart to treat all accessible airways in both lungs, except for the right middle lobe.

Bronchial thermoplasty is not intended to be performed on individuals with asthma who have a known sensitivity to atropine, benzodiazepines, lidocaine or for those with a pacemaker, implantable cardioverter defibrillator or other implantable electronic devices.

Coverage Determination

Humana members may NOT be eligible under the Plan for bronchial thermoplasty. This is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Background

Additional information about asthma may be found from the following websites:

  • American Academy of Allergy, Asthma and Immunology
  • American Lung Association
  • National Library of Medicine
Medical Alternatives

Alternatives to bronchial thermoplasty include, but may not be limited to, the following:

  • Prescription drug therapy

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes.

Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

CPT® Code(s)

31660 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed: with bronchial thermoplasty, 1 lobe. Not Covered

31661 - Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes. Not Covered

CPT® Category III Code(s)

No code(s) identified.

HCPCS Code(s)

Catheter, extravascular tissue ablation, any modality (insertable) - Not Covered if used to report bronchial thermoplasty.

References
  1. Agency for Healthcare Research and Quality (AHRQ). Comparative Effectiveness Review. Effectiveness and safety of bronchial thermoplasty in management of asthma. https://www.ahrq.gov. Published December 2017. Accessed June 14, 2023.
  2. American Academy of Allergy, Asthma and Immunology (AAAAI). Algorithm for the diagnosis and management of asthma: a practice parameter update. https://www.aaaai.org. Published November 1998. Accessed June 15, 2023.
  3. American Academy of Allergy, Asthma and Immunology (AAAAI). Attaining optimal asthma control: a practice parameter. https://www.aaaai.org. Published October 7, 2005. Accessed June 15, 2023.
  4. American Academy of Allergy, Asthma and Immunology (AAAAI). Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. https://www.aaaai.org. Published December 2010. Accessed June 15, 2023.
  5. American Academy of Allergy, Asthma and Immunology (AAAAI). Practice Parameter. Exercise-induced bronchoconstriction update – 2016. https://www.aaaai.org. Published May 25, 2016. Accessed June 15, 2023.
  6. American College of Allergy, Asthma and Immunology (ACAAI). Statement on bronchial thermoplasty. https://www.acaai.org. Published January 5, 2018. Accessed June 15, 2023.
  7. American College of Chest Physicians (ACCP). Position Statement. Coverage and payment for bronchial thermoplasty for severe persistent asthma. https://www.chestnet.org. Published May 12, 2014. Accessed June 15, 2023.
  8. American Thoracic Society (ATS). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. https://www.thoracic.org. Published 2014. Accessed June 15, 2023.
  9. ClinicalKey. Feller-Kopman D, Shojaee S. Therapeutic bronchoscopy: interventional techniques. In: Broaddus V, Ernst J, King T, et al., Murray & Nadel’s Textbook of Respiratory Medicine. 7th ed. Elsevier; 2022:388-398.e3. https://www.clinicalkey.com. Accessed June 26, 2023.
  10. ClinicalKey. Lugogo N, Que L, Carr T, Kraft M. Asthma: diagnosis and management. In: Broaddus V, Ernst J, King T, et al., Murray & Nadel’s Textbook of Respiratory Medicine. 7th ed. Elsevier; 2022:831-849.e6. https://www.clinicalkey.com. Accessed June 26, 2023.
  11. ClinicalKey. Viswanathan R, Busse W. Management of asthma in adolescents and adults. In: Burks A, Holgate S, O’Hehir R, et al., Middleton’s Allergy: Principles and Practice. 9th ed. Elsevier; 2020:858-890.e1. https://www.clinicalkey.com. Accessed June 26, 2023.
  12. ECRI Institute. Clinical Evidence Assessment.
  1. ECRI Institute. Emerging Technology Report. Bronchial thermoplasty (Alair system) for treating adult patients with severe symptomatic asthma. https://www.ecri.org. Published February 14, 2011. Updated October 15, 2014. Accessed June 14, 2023.
  2. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. https://www.ginasthma.org. Published 2023. Accessed June 14, 2023.
  3. Hayes, Inc. Health Technology Assessment. Bronchial thermoplasty for treatment of asthma in adults. https://evidence.hayesinc.com. Published July 5, 2022. Accessed June 14, 2023.
  4. MCG Health. Bronchial thermoplasty. 27th edition. https://www.mcg.com. Accessed June 19, 2023.
  5. Merck Manual: Professional Version. Asthma. https://www.merckmanuals.com. Updated March 2022. Accessed June 14, 2023.
  6. National Heart, Lung and Blood Institute (NHLBI). 2020 focused updates to the asthma management guidelines: a report from the National Asthma education and prevention program coordinating committee expert panel working group. https://www.nhlbi.nih.gov. Updated July 5, 2021. Accessed June 15, 2023.
  7. UpToDate, Inc. Mechanisms and clinical implications of glucocorticoid resistance in asthma. https://www.uptodate.com. Updated May 2023. Accessed June 14, 2023.
  8. UpToDate, Inc. Treatment of severe asthma in adolescents and adults. https://www.uptodate.com. Updated May 2023. Accessed June 14, 2023.
  9. US Food & Drug Administration (FDA). Summary of safety and effectiveness data: Alair bronchial thermoplasty system. https://www.fda.gov. Published April 27, 2010. Accessed May 20, 2014.
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