For years, debate around endoscopic spine surgery centered on whether the technique was ready for broad adoption. Questions about safety, durability, and outcomes dominated discussions among surgeons, payers, and policymakers.
That era has passed.
Today, the more pressing problem is not whether endoscopic lumbar decompression works, but whether patients can access it. Increasingly, the answer is no — and the reason has less to do with medicine than with coding.
At the center of this access problem sits CPT 62380.
How We Got Here: The 2017 Coding Pivot
Prior to 2017, lumbar decompression procedures were coded based on the surgical work performed. Whether a surgeon used loupes, a microscope, or an endoscope, procedures such as laminotomy, discectomy, foraminotomy, and laminectomy were reported using established work-based codes like CPT 63030 and 63047.
That changed in 2017.
With the introduction of CPT 62380, the AMA simultaneously implemented new definitions that separated “dedicated endoscopic” decompression from traditional lumbar decompression codes. While the descriptors for 63030 and 63047 were not materially altered, accompanying CPT guidance mandated that procedures performed under continuous endoscopic visualization be reported exclusively using 62380.
The original intent was understandable: create a dedicated Category I code to track a maturing technology and support future valuation.
The unintended consequences have been substantial.
A Code That Restricts Access Rather Than Expands It
CPT 62380 is a single, global code that applies to all endoscopic lumbar decompressions, regardless of pathology or complexity. Unlike traditional decompression codes, it lacks stratification based on surgical intensity.
More importantly, CPT 62380 is inconsistently reimbursed. Many commercial payers continue to classify it as investigational. Medicare introduced it without stable national valuation. The result is predictable: routine denials.
In contrast, the same decompression — when coded as 63030 or 63047 — is typically covered. This discrepancy has real-world consequences. Patients who are clinically appropriate candidates for endoscopic decompression are often directed toward more invasive procedures, not because those procedures are better, but because they are payable.
Coding policy, rather than clinical judgment, is driving care decisions.
The Debate Has Shifted — But the Rhetoric Hasn’t
Opposition to endoscopic spine surgery has long relied on arguments about insufficient supporting data. While the clinical literature has evolved, many payer policies and professional objections continue to cite outdated assumptions and early-generation statistics. As a result, CPT 62380 has become a proxy for skepticism that no longer reflects current practice or knowledge. The code has outlived the controversy it was designed to address — but continues to carry its stigma.
The Core Problem: Coding by Tool Instead of Work
At its foundation, CPT 62380 violates a basic principle of surgical coding: procedures should be defined by the work performed, not the instrument used. CPT itself defines direct visualization as light-based visualization by eye, loupes, microscope, or endoscope. Yet endoscopic decompression is isolated into a separate code, even when the anatomic goals and surgical work are identical to those described by 63030 or 63047.
This inconsistency has created confusion, undervaluation, and unnecessary barriers to care — without improving patient safety or outcomes.
Why Eliminating CPT 62380 Improves Patient Care
Eliminating CPT 62380 does not eliminate endoscopic spine surgery. It removes an artificial barrier to accessing it.
Reintegrating endoscopic lumbar decompression into established, work-based codes would:
• Expand patient access to less invasive options
• Allow surgeons to choose the most appropriate technique without reimbursement penalties
• Restore valuation based on surgical complexity rather than optics
• Align payer decision-making with medical necessity, not methodologyIf additional technical effort associated with endoscopy requires recognition, that can be addressed through modifiers or add-on mechanisms — not by maintaining a standalone code that distorts care delivery.
Conclusion: It’s Time to Align Policy With Modern Spine Care
CPT 62380 was created to legitimize endoscopic spine surgery. In practice, it has done the opposite.
Today, it functions as a gatekeeper — restricting access, perpetuating outdated skepticism, and disconnecting coding policy from clinical reality.
Eliminating CPT 62380 and returning to work-based coding for lumbar decompression is not a step backward. It is a necessary correction — one that prioritizes patient access, respects surgical judgment, and aligns policy with modern spine care.
