This species is listed as Endangered on the basis of an area of occupancy estimated at 80 km² and reliance on areas of hot springs at high altitudes (resulting in severe fragmentation of the population) the extent and quality of which is undergoing a continuing decline because of the construction of geo-thermal hydro-electric stations and human disturbance. It qualifies for a threatened listing under criterion B2ab(iii).

This species has been recorded from Jiangxi, Gongbujiangda, Dangxiong-Yangbajin, Lhasa, Mozhugongka, and Shigatse, all in Xizang (Tibet), China (Guo and Chen 2000). It has been recorded along the Brahmaputra River. Within this area its distribution is apparently patchy, and it is known from around 20 sites (Hofmann et al. 2015) within its wide range, which lies in a remote area where surveys are difficult (Hofmann et al. 2012). It is found at elevations of 3,000 to 4,440 m asl.

The population was estimated as 13,000 individuals by State Forestry Administration of China (2009). Hofmann et al. (2012) conducted intensive targeted visual surveys (up to 5 ha/day over 4–6 weeks each season) in Yangbaijan between 2008 and 2011. They recorded 153 individuals across 12 sites, and suggested that individual subpopulations are likely to be small. The species is nonetheless "not difficult to find" during targeted surveys in suitable weather conditions (Hofmann et al. 2021).

Because of construction of geothermal infrastructure and human disturbance, the population of this species is presumed to be decreasing (Guo and Chen 2000). The species exhibits strong genetic structuring which appears to reflect a combination of high specificity to hot spring habitats with a naturally very patchy distribution (with suitable sites often tens of kilometres apart - Hofmann et al. 2012), and a low ability to disperse through intervening montane areas (Hofmann 2012). Although there is some gene flow and rivers may allow a degree of long-term dispersal, genetic exchange between subpopulations appears to be rare (Hofmann 2012, Hofmann et al. 2012). Combined with evidence of high site philopatry among females (Hofmann et al. 2012) this makes it is unlikely to recolonise any site from which it is lost.

This species is strongly associated with sulphur-free or low-sulphur hot spring habitats, characterized by water temperatures greater than 30 °C, which provide both warm basking areas and warm refuges during winter dormancy (Hofmann et al. 2012). Suitable sites also seem to require flowing water sources that support populations of amphibian and fish prey (and are hypothesized to represent the main route for long-distance dispersal, making it unlikely that subpopulations will establish far from rivers or streams - Hoffmann et al. 2012, 2021), and rocks and vegetated boulder slopes that provide basking and shelter sites (Hofmann et al. 2012). Ecological niche modelling using a combined sample of all three Thermophis species suggests that optimal sites for T. baileyi exhibit water temperatures between 45 and 100 °C and low winter precipitation, and along the tributaries of the Yarlung River (Hofmann et al. 2021).

Li (2007) found that this species mainly feeds on alpine frogs (Nanorana parkeri) and fish (Schizothorax o’connon and Triplophysa spp.) Reproduction is restricted to the short summer period, and males appear to disperse to locate site philopatric females (Hofmann et al. 2012). The female lays around six eggs.

The species is threatened by the potential construction of geothermal stations and human disturbance. Most of the hot springs in areas where the snake is found have been developed for commercial exploitation (Huang and Peng 2019). Road mortality may have a disproportionate impact on this species, as male dispersal during the breeding period is the only known mechanism of genetic exchange between subpopulations. Climate modelling projects that the species may lose the entirety of its "original habitat" by 2081–2100 (Li et al. 2013).

There are no reports of this species being utilised.

No conservation actions are currently known for this species. It is listed as Critically Endangered in the Chinese national Red List (Cai et al. 2016). It is a Class I protected animal in China. It is not known if the species is present in any protected areas. As this species has extremely specific habitat requirements and low rates of gene flow, the preservation of existing habitat is vital for the effective conservation of this species (Hofmann et al. 2012). These authors recommend including all known localities into a conservation plan for this species which limits human impacts, including geothermal development and disturbance during the reproductive period, as well as efforts to reduce road mortality. Population monitoring, and the restoration of wetlands and shelter sites, is strongly recommended by Huang and Peng (2019).