Aetna modified CPB 0744 for bronchial thermoplasty, effective November 27, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated its bronchial thermoplasty coverage policy under CPB 0744 to classify the procedure as experimental, investigational, or unproven for all indications — including asthma and COPD. CPT codes 31660 and 31661 are explicitly not covered under this policy. If your pulmonology or interventional bronchoscopy billing team submits claims for these codes against Aetna commercial plans, expect denials.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Bronchial Thermoplasty — CPB 0744 |
| Policy Code | CPB 0744 |
| Change Type | Modified |
| Effective Date | November 27, 2025 |
| Impact Level | High — full non-coverage designation for all indications |
| Specialties Affected | Pulmonology, interventional pulmonology, thoracic surgery |
| Key Action | Remove CPT 31660 and 31661 from covered charge capture for Aetna patients and update staff on denial expectations before scheduling procedures |
Aetna Bronchial Thermoplasty Coverage Criteria and Medical Necessity Requirements 2025
The Aetna bronchial thermoplasty coverage policy under CPB 0744 is unambiguous: there is no path to medical necessity approval for this procedure. Aetna does not consider bronchial thermoplasty medically necessary for any indication. The policy language uses the clinical and administrative designation of "experimental, investigational, or unproven" — which is the ceiling, not a starting point for appeals.
This matters for your prior authorization workflow. Even if your team submits a prior authorization request for CPT 31660 or 31661, the policy offers no criteria under which Aetna would approve coverage. Submitting a prior auth for a procedure explicitly designated as experimental is unlikely to result in approval. Save the administrative time and have that conversation with the ordering provider before the request goes out.
The ICD-10 range J41.0–J47.9 (chronic lower respiratory diseases, including asthma) and J67.0–J67.9 (hypersensitivity pneumonitis due to organic dust) are listed as diagnosis codes in the policy — but not as covered indications. They're listed specifically to reinforce that even these diagnoses, which are the clinical rationale for bronchial thermoplasty, do not qualify for reimbursement under this policy.
Aetna Bronchial Thermoplasty Exclusions and Non-Covered Indications
Aetna CPB 0744 draws a hard line. Bronchial thermoplasty is non-covered for every listed indication. That includes:
Asthma — The primary clinical indication for bronchial thermoplasty is severe, persistent asthma not controlled by inhaled corticosteroids and long-acting beta-agonists. Aetna does not cover it. The policy states that effectiveness "has not been established," which is the standard language Aetna uses when the clinical evidence doesn't meet its coverage threshold.
Chronic obstructive pulmonary disease (COPD) — The policy explicitly names COPD as an "other indication" that is also experimental. Any off-label use case for bronchial thermoplasty in COPD patients is excluded.
Other indications — The parenthetical "e.g." in the policy language signals that the list isn't exhaustive. Aetna treats the experimental designation as a blanket exclusion. There is no carve-out for research protocols, compassionate use, or specific patient profiles.
The real issue here is that bronchial thermoplasty has FDA clearance (the Alair Bronchial Thermoplasty System was cleared in 2010), but FDA clearance does not equal payer coverage. Aetna's clinical review team has concluded the long-term effectiveness data doesn't support routine coverage. That gap between FDA approval and payer acceptance is exactly where claim denials live.
Coverage Indications at a Glance
| Indication | Coverage Status | Relevant Codes | Notes |
|---|---|---|---|
| Severe persistent asthma | Not Covered — Experimental | CPT 31660, 31661; ICD-10 J41.0–J47.9 | Designated experimental; no medical necessity path |
| COPD | Not Covered — Experimental | CPT 31660, 31661; ICD-10 J41.0–J47.9 | Explicitly named as excluded indication |
| Hypersensitivity pneumonitis due to organic dust | Not Covered — Experimental | CPT 31660, 31661; ICD-10 J67.0–J67.9 | Included in non-covered diagnosis range |
| Other lower respiratory indications | Not Covered — Experimental | CPT 31660, 31661 | Blanket exclusion; "other indications" language used |
Aetna Bronchial Thermoplasty Billing Guidelines and Action Items 2025
This policy doesn't create complexity — it removes it. There is one coverage determination for bronchial thermoplasty under CPB 0744: not covered. Your action items are about protecting your revenue cycle from wasted effort and avoidable denials.
| # | Action Item |
|---|---|
| 1 | Pull CPT 31660 and 31661 from your Aetna charge capture templates now. The effective date is November 27, 2025. If your charge description master still includes these codes as billable to Aetna, you're set up for automatic denials. Flag these codes as non-covered for Aetna payer class. |
| 2 | Update your prior authorization screening protocol. Brief your scheduling and authorization staff: no prior auth submission for bronchial thermoplasty against Aetna plans. A PA denial on an experimental procedure still consumes staff time and creates a paper trail that complicates appeals. Skip the request and redirect to the coverage conversation with the patient and physician. |
| 3 | Flag active Aetna patients scheduled for bronchial thermoplasty. If you have patients with Aetna coverage who are scheduled for CPT 31660 or 31661, pull those cases before the procedure date. Have your financial counseling team discuss self-pay or alternative treatment options before the claim denial becomes a collections problem. |
| 4 | Review your ABN (Advance Beneficiary Notice) process — and extend it to commercial. ABNs are a Medicare tool, but the concept applies here. For Aetna commercial patients, your team should use a comparable financial responsibility agreement before providing a procedure the payer explicitly excludes. Document that the patient was informed the procedure is not covered and agreed to self-pay terms if they choose to proceed. |
| 5 | Check your secondary payer arrangements. If a patient carries Aetna as secondary and another commercial plan as primary, the secondary denial exposure still exists. Confirm the primary payer's stance on bronchial thermoplasty billing before assuming the secondary will cover a balance. |
| 6 | Discuss alternative treatment pathways with your clinical team. Aetna CPB 0744 references CPB 0670 for omalizumab (Xolair) as a related policy. If your pulmonologists are considering bronchial thermoplasty for severe asthma patients, the biologic route — covered under different criteria — may be the path that actually gets reimbursement. Loop in your medical director on this conversation. |
| 7 | If you're billing in a state with independent review or mandated coverage laws, talk to your compliance officer. Some states have external review processes that allow patients to challenge experimental designations. The facts here are straightforward — Aetna's policy is clear — but state-level protections can create exceptions. Your compliance officer should know your state's rules before you close the door on appeals entirely. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Bronchial Thermoplasty Under CPB 0744
Not Covered / Experimental CPT Codes
| Code | Type | Description | Coverage Status |
|---|---|---|---|
| 31660 | CPT | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty | Not covered — experimental, investigational, or unproven for all listed indications |
| 31661 | CPT | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes | Not covered — experimental, investigational, or unproven for all listed indications |
Both codes represent the same procedure at different treatment extents. CPT 31660 covers a single lobe session. CPT 31661 covers sessions involving two or more lobes. Bronchial thermoplasty is typically performed across three sessions targeting different lung regions — meaning a standard treatment course could involve both codes across multiple dates of service. None of those sessions are covered under Aetna CPB 0744.
Key ICD-10-CM Diagnosis Codes
These diagnosis codes appear in the policy specifically as part of the non-covered indication set. Pairing these codes with CPT 31660 or 31661 on an Aetna claim does not establish medical necessity — it confirms the claim falls within the excluded category.
| Code Range | Description |
|---|---|
| J41.0–J47.9 | Chronic lower respiratory diseases (includes chronic bronchitis, emphysema, asthma, bronchiectasis, and related conditions) |
| J67.0–J67.9 | Hypersensitivity pneumonitis due to organic dust (farmer's lung, bird fancier's lung, and related conditions) |
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