Payer Coverage for Bronchial Thermoplasty : Shifting the Traditional Paradigm for Refractory Asthma Therapy

The advent of bronchial thermoplasty (BT) provides a novel therapeutic option for asthma refractory to traditional medical therapy. Insurance coverage poses significant frustration for centers performing BT. Although clinical research has provided evidence of the usefulness and long-term safety of BT, establishing “reasonability and necessity” remains a daunting challenge in securing private and governmental insurance coverage. As a result, obtaining coverage poses significant frustration for centers capable of performing BT for patients suffering from severe asthma. Until recently, BT had been categorized by a temporary set of Current Procedural Terminology (CPT) codes as an emerging technology, service, or procedure (category 3). Based on increasing implementation of BT nationwide, the American Medical Association CPT Editorial Panel has assigned category 1 CPT codes for BT in their published 2013 professional edition. It is hoped that such a recommendation will reinforce the medical community's belief in the usefulness of BT and help facilitate decisions on insurance coverage. The ability to secure coverage for BT through physician advocacy and Centers for Medicare and Medicaid Services support will help move the treatment of refractory asthma forward.