October 5, 2012 — The American Medical Association (AMA) Current Procedural Terminology (CPT 1) Editorial Panel has assigned Category I CPT codes specifically for bronchial thermoplasty in its recently published CPT 2013 Professional Edition. Beginning Jan. 1, 2013, physicians and hospitals will be able to seek reimbursement through two new codes to describe the bronchial thermoplasty procedure. Category I CPT procedure codes are recognized by all public and private health insurance payers in the United States.
"The American Thoracic Society is pleased that starting January 2013 physicians will have Category I CPT codes for coding and billing bronchial thermoplasty," said Monica Kraft, M.D., president, American Thoracic Society. "The ATS played a pivotal role in petitioning for the Category I CPT codes and we applaud the AMA CPT Editorial Panel for its decision to adopt the codes. The ATS notes several recent peer reviewed publications have indicated the safety and efficacy of bronchial thermoplasty in well-defined patient populations. We expect the Category I CPT codes will expand patient access to this new asthma therapy."
According to the AMA, criteria for a procedure to be awarded Category I CPT codes include:
- The suggested procedure/service is a distinct service performed by many physicians/practitioners across the United States; and
- The clinical efficacy of the service/procedure is well established and documented in U.S. peer-reviewed literature.
"The CPT Editorial Panel's decision is not only a major reimbursement milestone for bronchial thermoplasty, but we believe it is also an indication of the strength of the clinical evidence and the tremendous support for the procedure amongst pulmonary physicians," said David Pierce, president, Boston Scientific Endoscopy.
"These codes should provide greater access to treatment for patients with poorly controlled severe asthma, help facilitate easier claims processing and help accelerate private payers' coverage of this much-needed treatment option."
The Alair Bronchial Thermoplasty System is an FDA-approved device used in a bronchoscopic procedure performed under moderate sedation. The Alair System delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. It is designed to decrease the ability of the airway to constrict, thereby reducing asthma attack frequency and severity for patients whose asthma is not well controlled with inhaled corticosteroids and long-acting beta-agonists. Clinical trial results, which have been published in multiple peer-reviewed articles, demonstrate safety out to five years and persistence of clinical benefit out to at least two years.
For more information: www.bostonscientific.com