Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Bronchial Thermoplasty

Policy #:11.16.07b

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

MEDICALLY NECESSARY
Bronchial thermoplasty performed in a series of three treatment sessions with a recovery period of three weeks or longer between sessions is considered medically necessary and, therefore, covered when all of the following criteria are met:
  • The individual has been diagnosed with severe persistent asthma.
  • The individual has been managed by an asthma specialist (e.g., pulmonologist, allergist/immunologist) for at least six months prior to consideration for bronchial thermoplasty
    • Asthma specialist ensures that individual education, environmental factors, comorbidities and the exclusion of other possible diagnoses (e.g., gastroesophageal reflux disease [GERD], obstructive sleep apnea [OSA], allergic rhinitis, vocal cord dysfunction, chronic obstructive pulmonary disease [COPD], congestive heart failure, obesity, rhinosinusitis, anxiety/depression), have been considered in the management of the individual's severe persistent asthma
  • The individual manifests the following characteristics, despite appropriate use of asthma controller medications:
    • Daily symptoms (e.g., coughing, wheezing, chest tightness, shortness of breath)
    • Night time awakenings, every night
    • Use of rescue medication several times per day
    • Normal activities are extremely limited
  • The individual has a pre-bronchodilator forced expiratory volume in one second [FEV1] greater than 50 percent of predicted value
  • The individual's asthma is refractory to either high-dose inhaled corticosteroids (greater than 1000 mcg beclomethasone per day or equivalent) and long-acting beta-agonists (at least 100 mcg salmetrol per day or equivalent), or chronic oral corticosteroids (at a dosage of up to, but not greater than 10 mg per day, or 20 milligrams every other day are acceptable) despite individual's compliance with tolerated maximum therapy for a period of at least three consecutive months. This is demonstrated by the individual having two or more exacerbations in the preceding 12 months which is demonstrated by any of the following:
    • For individuals taking inhaled corticosteroids and long-acting beta agonists: asthma symptoms required oral systemic corticosteroids
    • Unscheduled professional provider's office visit due to asthma symptoms
    • Emergency department visit due to asthma symptoms
    • Hospitalization due to asthma symptoms
  • The individual is either not a candidate (e.g., non-allergic phenotype, normal IgE levels, cannot tolerate side effects or allergy) or is refractory to a trial of anti-IgE therapy or anti-Interleukin (Il)-5 therapy
  • The individual is age 18 years or older
  • The individual is a non-smoker for one year or greater
    • If former smoker, less than ten pack years total smoking history

NOT MEDICALLY NECESSARY

Repeat procedures of bronchial thermoplasty beyond the initial three treatment sessions is considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support its use in the treatment of illness or injury.

ABSOLUTE CONTRAINDICATIONS
Bronchial thermoplasty is considered not medically necessary and, therefore, not covered for individuals with any of the following absolute contraindications:
  • Pacemaker, internal defibrillator, or other implantable electronic devices
  • Known sensitivity to medications required to perform bronchoscopy, including lidocaine, atropine, and benzodiazepines
  • Same area(s) previously treated with bronchial thermoplasty
  • Any of the following conditions present:
    • Active respiratory infection
    • Asthma exacerbation or changing doses of systemic corticosteroids for asthma (up or down) in the past 14 days
    • Known coagulopathy

EXPERIMENTAL/INVESTIGATIONAL

All other uses for bronchial thermoplasty are considered experimental/investigational and, therefore, not covered because their safety and/or effectiveness cannot be established by review of the available published peer-reviewed literature.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

In accordance with the National Cancer Institute, a pack year is a way to measure the amount an individual has smoked over a long period of time. It is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the individual has smoked. For example, one pack year is equal to smoking one pack per day for one year, or two packs per day for half a year, and so on.

Bronchial thermoplasty should be performed by professional providers who are experienced in bronchoscopy and have completed the bronchial thermoplasty training curriculum.

CLASSIFICATION OF SEVERE PERSISTENT ASTHMA

Adapted from 2007 National Heart, Lung, and Blood Institute (NHLBI)
Components of SEVERITY
Severe Persistent Asthma
Impairment
SymptomsThroughout the day
Nighttime awakeningsEvery night
Short acting beta agonist for symptom control (rescue medication)Several times per day
Interference with normal activityExtremely limited
Lung Function: FEV1Less than 60 percent of predicted value
Risk
Exacerbations requiring oral corticosteroidsTwo or more exacerbations per year


GUIDELINES FOR ASTHMA MANAGEMENT

Stepped Approach Guidelines for Asthma Management
Adapted from 2007 NHLBI (Revised 2012)
Stepped Approach
Agents
Disease Severity
Step 1
Short-acting B2-agonists as needed
Intermittent disease
Step 2
Low-dose inhaled corticosteroids (ICS)
Mild persistent disease
Step 3
ICS and long acting B2-agonists (LABA) or medium-dose ICS
Moderate persistent disease
Step 4
Medium-dose ICS and LABA
Severe persistent disease
Step 5
High-dose ICS and LABAs; consider omalizumab if allergies present
Severe persistent disease
Step 6
High-dose ICS and LABA, and oral corticosteroids; consider omalizumab if allergies present
Severe persistent disease

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, bronchial thermoplasty is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

The Alair® Bronchial Thermoplasty System: Alair® Catheter and Alair® RF Controller (Asthmatx, Inc., Sunnyvale, CA, now part of Boston Scientific Corporation) was approved by the FDA on April 27, 2010.


Description

Asthma is a common chronic respiratory disease characterized by inflammation of the airways, excess mucus production, and airway hyper-responsiveness, a condition in which airways narrow excessively in response to a stimulus. Asthma attacks have significant impact on an individual's life, limiting participation in many activities. Severe asthma is classified as incapacitating with the inability to do work or usual activities, requiring medical intervention and/or treatment. In severe cases, asthma attacks can be life threatening. Individuals with severe asthma often have increased airway smooth muscle mass. Higher deposition of smooth muscle mass within the airway submucosa, increased expression of contractile proteins, and amplified activation of smooth muscle contractile units likely contribute to the extreme airway hyper-responsiveness and bronchoconstriction witnessed in severe asthma.

The management of asthma often consists of environmental control, patient education, and medical management. Guidelines from the National Heart, Lung, and Blood Institute (NHLBI) define six pharmacologic steps ranging from short-acting beta-agonists to high-dose inhaled corticosteroids. Despite this multidimensional approach, there remain individuals with refractory asthma. Therefore, novel therapies such as bronchial thermoplasty have been developed as a therapeutic consideration for some carefully chosen individuals with severe, refractory asthma who continue to be symptomatic despite maximal medical management. By controlled delivery of radiofrequency energy to heat tissues in the distal airways, the technology is based on the premise that individuals with asthma have an increased amount of airway smooth muscle and that contraction of this muscle is a major cause of airway constriction. Therefore, radiofrequency energy aims to reduce the amount of airway smooth muscle, thereby decreasing the bronchoconstriction.

Alair® Bronchial Thermoplasty System (Boston Scientific, Inc.) is composed of two primary components:
  • Alair® Catheter – The Alair® Catheter is a single-use device designed to be delivered through the working channel of a standard bronchoscope.
  • Alair® Radiofrequency (RF) Controller – The Alair® RF Controller is designed with a proprietary set of control parameters and algorithms to deliver the correct intensity and duration of thermal energy sufficient to reduce the mass of airway smooth muscle tissue, while limiting long-term impact to surrounding tissues.

On April 27, 2010, the US Food and Drug Administration (FDA) approved the Alair® Bronchial Thermoplasty System for the treatment of severe persistent asthma in individuals 18 years of age and older whose asthma is not well controlled with inhaled corticosteroids and long-acting beta-agonists, the current standard-of-care for these individuals. The FDA required a five year post-approval study of the device to study its long-term safety and effectiveness.

Bronchial thermoplasty is typically performed as an outpatient procedure and is expected to complement asthma maintenance medications as an add-on therapy that decreases morbidity associated with severe asthma. During this procedure, the physician introduces a standard flexible bronchoscope through an individual's nose or mouth, and into airways of the lung. A small-diameter catheter is delivered into the airways through the working channel of the bronchoscope, and the tip of the catheter is expanded to contact the walls of targeted airways. Controlled radiofrequency energy is delivered to the airway wall for a maximum of ten seconds to heat the tissue in order to reduce airway smooth muscle mass. Reducing airway smooth muscle is believed to decrease muscle mediated bronchoconstriction, thereby reducing asthma symptoms and exacerbations. A contiguous series of thermal energy applications are needed to treat the length of the larger conducting airways that are accessible with a bronchoscope. Once the treatment session is completed, the device and the bronchoscope are removed. The treatment is typically performed in a series of three separate procedures, covering different regions of the lung, each scheduled about three weeks apart. After all three procedures are performed, the bronchial thermoplasty treatment is complete. No clinical data are available studying the safety and/or effectiveness of further repeated bronchial thermoplasty treatments on the same area of the lung.

PEER-REVIEWED LITERATURE

In a randomized, double blinded, sham controlled pivotal clinical trial (Asthma Intervention Research [AIR] study), Cox et al. (2007) reported one year results on bronchial thermoplasty's safety and efficacy for treating moderate to severe, symptomatic persistent asthma. Eligibility criteria met by the 112 study participants included age 18 to 65 years with moderate to severe persistent asthma requiring daily inhaled corticosteroids (equivalent to 200 mcg or more of beclomethasone) and inhaled long-acting beta agonists (100 mcg or more) and demonstrated worsening of asthma on long-acting beta agonists withdrawal. The study evaluated the rates of mild asthma exacerbations at one year follow-up in individuals undergoing bronchial thermoplasty compared to those undergoing medical management. The mean rate of mild asthma exacerbations was significantly reduced in the bronchial thermoplasty group (-0.16 versus 0.04; p = 0.005), but was unchanged in the medical management control group. At 12 months, there were significantly greater improvements in the bronchial thermoplasty group than in the medical management control group in the morning peak expiratory flow, scores on the Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ), the percentage of symptom-free days, and symptom scores, while fewer puffs of rescue medication were required. Values for airway responsiveness and forced expiratory volume in one second did not differ significantly between the two groups. Adverse events immediately after treatment were more common in the bronchial thermoplasty group than in the medical management control group, but were similar during the period from six weeks to 12 months after treatment. The reported increase in respiratory adverse events in the short term represented the further aggravation of the worsening of asthma symptoms that is associated with bronchoscopy in individuals with asthma. The authors ultimately concluded from the AIR study that bronchial thermoplasty in individuals with moderate or severe asthma results in an improvement in asthma control.

In Thomson et al. (2011), study participants completing the 12-month follow-up in the AIR Trial were invited to participate in a five year post-treatment extension study to evaluate longer-term safety under a new protocol. Forty-two individuals in the bronchial thermoplasty group, and 24 individuals in the medical management control group opted to participate. The exclusion criteria for participation in the extension study were: participation in another clinical trial involving respiratory intervention, or new diagnosis of psychiatric disorder, which, in the judgment of the investigator, could interfere with provision of informed consent, completion of tests, therapy, or follow-up. There was no increase in hospitalization or emergency department visits for respiratory symptoms in years two, three, four, and five compared to year one. The forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) values showed no deterioration over the five year period in the bronchial thermoplasty group. Similar results were obtained for the control group undergoing medical management. The authors concluded that the absence of clinical complications (based on adverse event reporting) and the maintenance of stable lung function (no deterioration of FVC and FEV1) over a five year period post--bronchial thermoplasty in this group of study participants with moderate to severe asthma, support the long-term safety of bronchial thermoplasty out to five years.

In a randomized controlled trial (RISA study) consisting of 32 study participants, Pavord et al. (2007) evaluated the rate of respiratory adverse events in a bronchial thermoplasty group when compared to a control group undergoing medical management at one year follow-up. The primary outcome was a safety measurement. Despite this, no overall statistical analysis comparing serious adverse events between the two groups was reported. Study participants in the bronchial thermoplasty group had a higher rate of adverse events (136 versus 57) during the treatment period, including seven hospitalizations for four participants in the bronchial thermoplasty group and zero for the medical management group. The rate of hospitalizations was similar in both groups in the post-treatment period. As a secondary outcome, those in the bronchial thermoplasty group had significant improvements compared to the medical management group in rescue medication use, FEV percent predicted, and asthma questionnaire scores. There was no significant difference between groups in other efficacy outcomes including morning and evening peak expiratory flow, symptom scores, number of symptom-free days, improvement in FEV-1 predicted, and several quality of life measures. The authors concluded that bronchial thermoplasty is associated with a short-term increase in asthma related morbidity. However, there is evidence of long-lasting improvement in asthma control.

In a five year single-arm follow-up to the RISA study, Pavord et al. (2013), evaluated the annual rate of respiratory adverse events in the bronchial thermoplasty group. Fourteen of the 15 in the bronchial thermoplasty group were studied to endpoint, with one individual lost to follow-up due to death. The rate of adverse events was 1.4, 2.4, 1.7, and 2.4, respectively, in years two through five after bronchial thermoplasty. Secondary outcomes indicated that at five year follow-up, half of the 14 study participants were taking maintenance medications, of which four had decreased dosage, two had the same dose, and one had an increased dose. The other seven study participants did not take maintenance medication at baseline. The authors concluded that the study findings suggest that bronchial thermoplasty is safe for five years after bronchial thermoplasty in individuals with severe refractory asthma.

In a multicentered, randomized, double blind, clinical trial (AIR2 study), Castro et al. (2010) evaluated the difference in AQLQ results in a bronchial thermoplasty group when compared to a sham-control group. A total of 288 study participants were enrolled, with 190 individuals undergoing bronchial thermoplasty. All study participants had severe asthma based on the need for therapy with high-dose inhaled corticosterioids and long-acting beta agonists, high ACQ scores and low AQLQ scores. There was a statistically significant improvement in AQLQ in the bronchial thermoplasty group when compared to the sham group:
  • Thirty-two percent reduction in severe exacerbations requiring systemic steroids
  • Eighty-four percent reduction in emergency department visits for respiratory symptoms
  • Sixty-six percent reduction in days lost from work, school or other daily activities due to asthma symptoms
  • Thirty six percent reduction in proportion of individuals reporting asthma (multiple symptoms) adverse events

In a five year single-arm follow-up to the AIR2 study, Wechsler et al. (2013) evaluated the annual rate of respiratory adverse events for 162 individuals in the bronchial thermoplasty arm of the initial study. For this study, there was no control group; rather, outcomes over the five years of follow-up were compared with those in the same individuals at baseline and during the 12 months preceding bronchial thermoplasty. The primary outcome was a safety related measure. The rate of adverse events was reduced at one year follow-up and remained stable up to five year follow-up. Secondary outcomes indicated that from baseline to five year follow-up, 28 percent of all study participants had reductions of 50 percent or more of their medications, with five percent of all study participants having an increase of 50 percent or greater in their medications. The investigators concluded that bronchial thermoplasty should be considered for individuals with severe persistent asthma who remain symptomatic despite taking inhaled corticosteroids and long-acting beta agonists.

Long-term follow-up out to five years has been completed in the AIR Extension Study, the RISA Extension Study, and the AIR2 Extension Study. Data from each of these studies have shown no safety signal of concern. There has been an absence of any late clinical complications (specifically respiratory events) and a stable adverse event profile has been established based on emergency department visits and hospitalizations for respiratory symptoms, and maintenance of stable lung function. An assessment in the AIR2 Extension Study (years one, three, and five after bronchial thermoplasty) showed no structural changes that were of clinical significance, again demonstrating the long-term safety of bronchial thermoplasty.

In a subsequent “real-world” study (Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma or PAS2), (Chupp et al. 2017), 190 individuals treated with bronchial thermoplasty were compared with the 190 individuals treated with bronchial thermoplasty in the AIR2 trial described above. The PAS2 participants, compared with AIR2 participants, experienced more exacerbations (74 versus 52 percent) and hospitalizations (15.3 versus 4.2 percent) in the prior 12 months. At three years after bronchial thermoplasty, severe exacerbations, emergency department visits, and hospitalizations decreased significantly in the PAS2 participants by 45 percent, 55 percent and 40 percent, respectively, which is comparable to the AIR2 results. However, adverse reactions, such as severe exacerbations (55.8 percent) and emergency department visits (15.8 percent), were more frequent during the treatment phase than in AIR2.

ASTHMA QUESTIONNAIRES

The AQLQ is a validated tool that measures the functional problems that are most troublesome to adults with asthma. The questionnaire consists of 32 questions in four domains: symptoms, activity limitation, emotional function, and environmental stimuli. Individuals rate their own levels of impairment from seven (not impaired at all) to one (severely impaired). Higher AQLQ scores represent greater functionality.

The ACQ is another validated instrument that measures overall asthma control, including minimization of symptoms, activity limitation, bronchoconstriction, and rescue medication use. The ACQ has seven sections: five pertaining to universal symptoms of asthma (i.e., awakened at night by symptoms, wake in the mornings with symptoms, limitation of daily activities, shortness of breath, and wheezing), one pertaining to daily rescue bronchodilator use, and one for FEV1. Individuals score five questions from zero (no impairment) to six (maximum impairment) and daily rescue bronchodilator use from zero (no use) to six (greater than 16 puffs most days). Forced expiratory volume in one second is rated from zero (greater than 95 percent predicted) to six (less than 50 percent predicted). A final ACQ score is between zero (well controlled) and six (severely uncontrolled).

The validated Asthma Control Test (ACT ) includes four symptom/reliever questions plus a self assessed level of control. The ACT assesses the frequency of shortness of breath and general asthma symptoms, use of rescue medications, the effect of asthma on daily functioning, and overall self-assessment of asthma control. The scores range  from five (poor control of asthma) to 25 (complete control of asthma), with higher scores reflecting greater asthma control. An ACT score greater than 19 indicates well controlled asthma. 

PRACTICE GUIDELINES AND POSITION STATEMENTS

Professional societies and expert groups have issued updated guidelines and position statements regarding bronchial thermoplasty. In 2012, the Asthma and Allergy Foundation of America (AAFA) issued a letter in support of bronchial thermoplasty for individuals whose severe asthma is not well managed by less invasive therapies and whose professional providers deem it appropriate. Asthma and Allergy Foundation of America's support is based on long-term safety results of the AIR and AIR2 trials, demonstrating maintenance of stable lung function and absence of clinical complications for individuals over a five year period.

In 2014, the British Thoracic Society (BTS) noted that bronchial thermoplasty has been shown to reduce the frequency of severe asthma attacks, emergency department visits, and days lost from school or work in the year after treatment. Emergency department visits, but not severe asthma attacks, are reduced in the period from first treatment to one year post-treatment. The reduction in the frequency of asthma attacks and emergency department visits may persist for up to five years after treatment.

In 2014, the American College of Chest Physicians issued a position statement based on the strength of the clinical evidence that bronchial thermoplasty offers treatment for individuals with severe asthma who continue to be symptomatic despite maximal medical treatment. In addition, they also note that the California Technology Assessment Forum (CTAF) reviewed available evidence and found that the use of bronchial thermoplasty for the treatment of severe, refractory asthma meets CTAF Technology Assessment Criterion one through five for safety, effectiveness, and improvement in net health outcomes.

In 2014, the Global Initiative for Asthma (GINA) updated their evidence based report on prevention and management of asthma and recommended consideration of bronchial thermoplasty for selected adult individuals with uncontrolled asthma despite use of recommended therapeutic regimens (Evidence B).

In 2015, bronchial thermoplasty received support from the American College of Allergy, Asthma, and Immunology (ACAAI) as a well studied, therapeutic consideration for some carefully chosen individuals with severe, difficult-to-control asthma who continue to be symptomatic despite maximal medical treatment including steroids, long-acting beta agonists, long-acting muscarinic agents, leudotriene antagonists, and biologics.

In 2015, the Allergy & Asthma Network (AAN) issued a position statement based on scientific literature for bronchial thermoplasty as an effective therapy for individuals with severe persistent, poorly controlled asthma who continue to experience asthma exacerbations, emergency department visits, and hospitalizations despite the best medical treatment.
References


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US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Alair® Bronchial Thermoplasty System. Summary of Safety and Effectiveness. [FDA Web site]. 04/27/2010. Available at:
http://www.accessdata.fda.gov/cdrh_docs/pdf8/P080032b.pdf. Accessed May 04, 2018.

Wahidi MM, Kraft M. Bronchial thermoplasty for severe asthma. Am J Respir Crit Care Med. 2012;185(7):709-714.

Wechsler ME, Laviolette M, Rubin AS et al. Bronchial thermoplasty: long-term safety and effectiveness in patients with severe persistent asthma. J Allergy Clin Immunol.2013; 132(6):1295-1302.

Wenzel S. Treatment of severe asthma in adolescents and adults. 01/30/2015. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed March 10, 2015.

Wenzel S. Treatment of severe asthma in adolescents and adults. [UpToDate Web site]. 03/02/8. Available at: https://www.uptodate.com/contents/treatment-of-severe-asthma-in-adolescents-and-adults/print [via subscription only]. Accessed May 04, 2018.

Wu Q, Xing Y, Zhou X, Wang D. Meta-analysis of the efficacy and safety of bronchial thermoplasty in patients with moderate-to-severe persistent asthma. J Int Med Res. 2011;39(1):10-22.

Zamora L. Bronchial thermoplasty for asthma. Horizon Scanning Technology Prioritizing Summary. Canberra, ACT: Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S); August 2007.






Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

31660, 31661


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

J45.50 Severe persistent asthma, uncomplicated


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

Revisions from 11.16.07b:
06/06/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Bronchial Thermoplasty.


Effective 10/05/2017 this policy has been updated to the new policy template format.

Version Effective Date: 07/14/2017
Version Issued Date: 07/14/2017
Version Reissued Date: 06/06/2018

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