Minimally invasive spine surgery keeps redefining itself — not just through new technique, but through new arguments about what “minimally invasive” should even mean. In 2026, that tension is playing out everywhere from CMS payment rules to the operating room itself, where some surgeons are starting to ask whether the real advance isn’t a smaller incision, but a smaller operation altogether.
Here are the developments shaping the field this year:
1. CMS strengthened reimbursement for a key endoscopic code. CMS increased the Medically Unlikely Edit for CPT 64772 (endoscopic medial branch transection) from 2 to 6 units for 2026. The move was described by one spine surgeon as a “national-level acknowledgment that endoscopic techniques can fall under existing CPT codes.”
2. A major insurer added coverage for a minimally invasive back pain treatment. Health Care Service Corp. granted coverage for Boston Scientific’s Intracept procedure, a minimally invasive treatment for chronic vertebrogenic low back pain, effective December 2025.
3. The site-of-service payment gap remains wide, and it will not be closed in 2027. Medicare’s 2026 ASC conversion factor sits at $56.322 versus $91.415 for hospital outpatient, and the 2027 proposed rule keeps the gap roughly intact at $57.766 versus $102.004.
4. Endoscopic spine surgery still faces a heavy learning curve and lagging reimbursement. Despite growing clinical evidence, surgeons say endoscopic adoption remains stalled by the time and cost required to build proficiency, combined with reimbursement that hasn’t caught up to the technique’s complexity.
5. Some surgeons argue true progress means operating on fewer levels, not more. Gregory Mundis Jr., MD, who has pushed minimally invasive technique into some of spine surgery’s largest deformity reconstructions, now argues the more consequential advance is better diagnosis: identifying which patients never needed a large reconstruction in the first place. “The more you fuse, in my mind, the less minimally invasive it actually is,” said Dr. Mundis, chief of the spine section at Scripps Memorial Hospital La Jolla in San Diego.
6. Motion preservation is becoming the starting point, not the fallback. Scott Blumenthal, MD, of Texas Back Institute in Plano, said the field is seeing “continued expansion of indications for motion preservation,” driven substantially by patients seeking alternatives to fusion.
7. Surgeons are drawing sharper lines around who actually benefits from surgery. David Russo, DO, of Columbia (Mo.) Pain Management, described “a clearer differentiation between patients who truly benefit from surgery and those who do not,” with restraint and judgment increasingly framed as the field’s defining skill.
8. MIS is linked to lower opioid use, and the endoscopic learning curve has been quantified. A March 2026 Global Spine Journal study associated minimally invasive spine surgery with reduced postoperative opioid consumption, with endoscopic procedures showing the lowest average use. A separate systematic review the same month found a median of 20 cases to reach proficiency with uniportal endoscopic technique versus 37.5 cases for biportal.
9. 2026 is being called the year of “convergence.” Michael Rivlin, MD, of Rothman Orthopaedic Institute in Philadelphia, used that term to describe advanced image guidance, AI-driven optimization, and robotics merging with value-based outcomes tracking into a single surgical workflow.
10. CMS’ 2026 “efficiency adjustment” is drawing direct pushback. A finalized 2.5% cut for many non-time-based services assumes MIS techniques reduce surgical complexity — an assumption Morgan Lorio, MD, former president of the International Society for the Advancement of Spine Surgery, called a “silent erosion of value” that ignores patient acuity and postoperative responsibility.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
