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Topics in Practice Management |

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

Amit K. Mahajan, MD; D. Kyle Hogarth, MD, FCCP
Author and Funding Information

From the Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.

Correspondence to: D. Kyle Hogarth, MD, FCCP, 5841 S Maryland, MC 6076, Chicago, IL 60637; e-mail: dhogarth@uchicago.edu


The authors contributed equally to the writing of this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):1051-1054. doi:10.1378/chest.13-0053
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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.


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