When CMS quietly updated the Medically Unlikely Edit (MUE) for CPT 64772 from two to six units for 2026, it didn’t make headlines, but it should have. This change isn’t simply a coding adjustment. It is a national-level acknowledgment that endoscopic techniques can fall under existing CPT codes when the underlying work is standard, anatomical surgical care. For those of us performing ultra–minimally invasive medial branch transection (MBT), this is a meaningful step forward.
CPT 64772 and Medial Branch Transection: Anatomy Meets Policy
CPT 64772 describes transection or avulsion of “other spinal nerves, extradural.” Spine surgeons use this code to report endoscopic medial branch nerve transection (MBT), a targeted surgical alternative to radiofrequency ablation that denervates the facet joints.
Each lumbar facet joint receives dual innervation from medial branches at adjacent levels. To fully treat two bilateral facet joints, six distinct nerves must be transected, each requiring a separate exposure, dissection, and closure.
Historically, CMS reimbursed only two units of 64772, regardless of how many nerves were actually treated. The result was predictable: staged procedures, incomplete treatment, and avoidable administrative burden. With the increase to six units nationally,
CMS has now aligned policy with anatomy and clinical practice.
Where the Debate Has Shifted: Evidence Has Caught Up
For years, payer resistance to endoscopic spine surgery centered on a perceived lack of supporting evidence compared to traditional open or MIS approaches. That argument no longer holds.
Multiple contemporary studies now demonstrate that endoscopic spine procedures are at least equivalent to open and tubular MIS techniques and in many cases show superior outcomes, including reduced tissue disruption, less postoperative pain, faster recovery, and lower complication rates.
The literature has evolved. The data are now robust. What has lagged behind is the rhetoric with some opponents continuing to cite outdated studies or early-era endoscopic outcomes that no longer reflect current technique, technology, or surgeon experience.
The CMS update to CPT 64772 reflects a growing recognition that policy must evolve alongside evidence, not trail it by a decade.
National Policy Is Set, But Local Implementation Still Varies
Here is the critical nuance surgeons need to understand: CMS has approved 6 units nationally, effective January 1, 2026. However, reimbursement is still determined regionally by each Part B Medicare Administrative Contractor (MAC). Each MAC must now adopt this national change into its local adjudication systems, and the timing of that implementation is not yet known. Until that happens, coverage, payment amounts, and consistency may vary by region.
In other words: The national framework is now supportive, but uniform reimbursement is not guaranteed until all MACs complete their updates. This is why awareness, documentation clarity, and continued dialogue with local MACs are essential during the transition period.
The Ultra-Minimally Invasive Endoscope Question: Why This Decision Matters
MBT can be performed using open, tubular, or endoscopic techniques. The CPT descriptor doesn’t specify approach, only the anatomical work performed. Yet many MACs have historically denied endoscopic MBT as “experimental,” even when the same work, performed via open or tubular access, was covered. By updating the MUE for CPT 64772 to six units, and doing so without excluding endoscopic technique, CMS has set a powerful precedent: A standard CPT code can appropriately include an endoscopic approach when the underlying surgical work meets the code’s requirements. This challenges long-standing payer logic that endoscopic decompression or discectomy must have unique codes to be considered valid.
It raises the natural next policy question: If an endoscope is accepted for 64772, why not for 63030 (laminotomy) or 63047 (laminectomy)?
What Spine Surgeons Should Do Now
If you perform endoscopic MBT, here is what this change means:
• You may bill up to six units per day, provided documentation supports each distinct nerve transection.
• You may not bill more than six units (MUE Adjudication Indicator = 3).
• Expect regional variability until each MAC updates its claims systems.
• Use this precedent in appeals when payers deny claims based on technique rather than anatomical work.
A Step Forward, and Momentum for What Comes Next
This is progress, real progress.
But it is also part of a broader movement to modernize reimbursement for ultra–minimally invasive spine surgery.This update helps build momentum for:
• Resolving the 62380-code elimination
• Achieving consistent MAC interpretation for endoscopic decompression and discectomy
• Ensuring national-level policy ultimately translates into regional, uniform, predictable
reimbursement
• Reinforcing that coding should reflect surgical work, not the tool used to perform it
Coding should reflect what we do, not limit how we do it.
CMS just opened the door.
It is now up to us to keep pushing it forward.
