CPT codes for spine surgery may not always fit circumstances, and in some cases this prompts calls for reforms.
One of those codes, CPT 62380 has the attention of some spine surgeons. The code, for endoscopic lumbar decompression, stands alone and is applied uniformly across spinal levels.
However Morgan Lorio, MD, and Kai-Uwe Lewandrowski, MD, argue the code should be retired entirely because the code “fails to account for the variable intensity of work performed—from L5 to S1 extraforaminal decompression to a central stenosis release.”
In a brief report for the July 2025 issue of International Journal of Spine Surgery, they point out that other CPT codes for decompression benefit from specific valuation based on anatomy and complexity. Dr. Lorio and Dr. Lewandrowski say CPT 62380 seems to suggest that endoscopic spine isn’t “real” surgery unless categorized separately and opens the door for credentialing ambiguity.
And they aren’t alone in their stance. Four endoscopic spine surgeons weighed in on the matter with Becker’s.
Note: Responses were lightly edited for clarity.
Question: Do you think CPT 62380 should be removed? How else could this challenge be addressed?
Sanjay Konakondla, MD. Endoscopic Spine Institute of New York (New York City): We spent years going into the nuances of perfecting codes for spinal surgeries, and I agree with this article wholeheartedly.
The largest frustration is with the way the system is set up. We get paid for the work we show, not the work we save. So unfortunately, this creates a conflict and mixed incentives for doing “larger procedures” for larger reimbursement. In order to perfect techniques for superior patient outcomes, a significant amount of work, training and sacrifice needs to be purposefully applied. Endoscopic techniques in this sense are no different- as there is a steep learning curve that needs to be overcome when incorporating the techniques into your practice to yield its full benefits. But this value isn’t realized in the current system.
62380 was shortsighted. It’s a specific code for a lumbar procedure for a decompression done with an endoscope. The main problem here is that the endoscope use is not just one procedure in the lumbar spine. The endoscope is a tool used to treat so many spine pathologies once a particular skill set has been studied and practiced.
Clearly with this, it is easy to understand that it is not a code that could be applied for a lumbar synovial cyst, a tumor biopsy, a cervical decompression or foraminotomy, a calcified thoracic disc herniation, an endoscopic tethered cord release or any of the other pathologies we use an endoscope to address in our practice at The Endoscopic Spine Institute Of New York (ESINY). So as suggested in the article – it is totally unreasonable to create a whole family of endoscopic codes for the procedures we already perform in the spine that already have codes.
I would argue in fact that when done endoscopically — the work in time spent and mental effort should value more than traditional spine procedures. We all agree that the application of the endoscope to conventional spine procedures is a more technically demanding surgery. So the use of an endoscope should be additive to a conventional CPT spine code.
Ezriel Kornel, MD. Somers Orthopaedic Surgery & Sports Medicine Group (Carmel, N.Y.): I completely agree with the article that CPT 62380 should be eliminated. The purpose of the procedure is to unobstruct/decompress a nerve root that is being obstructed, distorted or compressed, whether it be by a herniated disc, thickened ligament, a bone spur or a cyst. The tools used are not the fundamental issue and an endoscope is simply a tool. We don’t have to have a special code when using a pituitary ronguer for example. The complexity of the case is not about the visualization or the tools but rather about the job that needs to be done. The surgeon can always use a modifier code if they feel that the procedure is more complex and difficult and time consuming then the standard approach. By the way, only a surgeon qualified in using a variety of surgical approaches to enter the spine should be qualified to use this endoscopic approach as well. Furthermore an add-on code could be utilized for the endoscope just as it is for the microscope.
Craig McMains, MD. OrthoIndy (Indianapolis): I 100% agree. Look, we need to have an honest conversation about CPT code 62380. This code is fundamentally broken — it treats a simple extraforaminal decompression the same as a complex central stenosis release. That’s like saying all shoulder surgeries are the same whether you’re doing a simple scope based decompression or a massive rotator cuff reconstruction. We’d never accept that logic anywhere else in surgery.
What really gets me is how this plays out in practice. Every spine surgeon I know wants to learn endoscopy – it’s clearly becoming the gold standard for minimally invasive decompression. But here’s the catch: many can’t even start because their hospitals are being told by insurance companies that this is “experimental surgery.” Experimental? We’re talking about a technique that’s been around for over 40 years with solid peer-reviewed evidence behind it.
Remember when shoulder arthroscopy faced the same resistance? Now it’s the absolute standard for rotator cuff repair. We’re watching history repeat itself, except this time it’s even more frustrating because the science is already there.
Here in Indiana, I’m seeing this firsthand. Anthem won’t cover the code at all, but Medicare does. So I’m supposed to tell my Medicare patients they can get the best care while my commercially insured patients get stuck with more invasive options? That’s not medicine – that’s bureaucracy interfering with patient care. And I can’t just use a different code because that’s billing fraud.
The insurance companies are using this coding mess as another excuse to deny care to patients who deserve better. Without proper RVU stratification that actually reflects the work we’re doing, we’re going to keep hitting these same walls.
This has become a personal battle for me, and I’d welcome the opportunity to take this case directly to CMS. It’s time we stop letting coding bureaucracy dictate surgical innovation.
Albert Telfeian, MD, PhD. Endoscopic Spine Institute of New York: I do agree with it being deleted. The original code for a discectomy was a sound one with an additional modifier for using a microscope. It would be logical to do the same thing for when an endoscope is used.
