Does Medicare Cover Bronchial Thermoplasty?

Asthma is a chronic inflammatory condition that occurs in a person’s airways. Common symptoms of asthma include breathlessness, coughing, and wheezing. There are many treatments for asthma including nebulizers and inhalers. One more recent type of treatment some seek is bronchial thermoplasty.

If this is a treatment your doctor is recommending and you are looking into, one question you may have is “does Medicare cover bronchial thermoplasty?” In this article, we answer that question in clear, plain English. We also will cover the costs for this procedure for those who pay out of pocket as well as some other helpful info.

Does Medicare Cover Bronchial Thermoplasty?

The short answer is yes. Medicare will cover the cost of bronchial thermoplasty. But not 100% of the time. As you will often find when dealing with Medicare coverage questions, certain conditions have to be met in order for Medicare to pay for your bronchial thermoplasty. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for bronchial thermoplasty. So long as the procedure is a medically necessary one, you should expect that Medicare will cover things for you or a loved one who has Medicare. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

However, there is not yet a National Coverage Determination for the procedure. That means you will need to first for the operation out of pocket. Once you do that you can get in touch with your local Medicare contractor. Then, once you are in there, you must submit a claim to your local Medicare contractor.

Part C Coverage for Bronchial Thermoplasty

Medicare Advantage plans (Medicare Part C) also provide coverage for bronchial thermoplasty. These Part C plan are required to cover all the same treatments, procedures and services that Original Medicare covers. They will also offer coverage for things that Original Medicare does not cover. Though you’ll need to check with your plan (or the plan you’re looking to sign up for) to see exactly what it covers and what your out-of-pocket costs will be.

What Is Bronchial Thermoplasty?

Bronchial thermoplasty is a procedure that treats asthma by reducing the thickness of the airway smooth muscle. This, in turn, improves the patient’s airflow and breathing.

This procedure is often outpatient, meaning patients do not need to stay in a hospital for days. It is approved by the FDA.

There are three segments of a full bronchial thermoplasty. Each segment is performed at least three weeks apart.

These segments include one for each lower lobe of the lung, making two operations, and one more on both the upper lobes. Once the patient is sedated, a catheter inside a bronchoscope is inserted in the mouth or nose, into the lungs.

Once it is inside, it will deliver thermal energy into the airways. After that, the patient will be monitored.

How Much Does Bronchial Thermoplasty Cost?

Bronchial thermoplasty may cost $5,000 to $20,000. This cost varies depending on the provider.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.