Retiring CPT 62380: Why Endoscopic Lumbar Decompression Should Be Defined by Surgical Work, Not Optics

• endoscopic spine surgery
• lumbar vertebrae/surgery
• minimally invasive surgical procedures
• health care economics and organizations
• reimbursement mechanisms
• current procedural terminology
• spinal stenosis/surgery
• relative value units
• health policy

Endoscopic spine surgery has gained traction in the United States, offering precision-based, minimally invasive access for decompression procedures with growing clinical utility. However, the conversation around reimbursement—particularly the Current Procedural Terminology (CPT) code 62380—has become increasingly fraught with contradictions, redundancies, and strategic pitfalls. It is time to ask a fundamental question: should we retire CPT code 62380 entirely?

The case for deletion is not anti-endoscopy. It is pro–surgical clarity.

Currently, code 62380 stands alone as a global code that is applied uniformly across spinal levels and pathologies. It fails to account for the variable intensity of work performed—from L5 to S1 extraforaminal decompression to a central stenosis release—while other decompression codes such as 63030, 63047, and their variants benefit from stratified valuation based on anatomy and complexity. This discrepancy creates inequities in reimbursement and distorts the value of the work being performed, especially in high-complexity cases.1

Worse, the logic underlying the existence of code 62380 existence is inconsistent with CPT’s own definitions. CPT clearly defines “direct visualization” to include endoscopy. Yet when it comes to applying traditional decompression codes, endoscopic techniques are often excluded, despite offering comparable or superior visualization to microscopes or loupes. The implication seems to be that endoscopy is somehow not “real” surgery unless categorized separately. This devalues both the surgeon’s skill and the innovation itself.

Compounding the issue is the unintended consequence that CPT code 62380 has opened the door for credentialing ambiguity. Nonsurgeons—including interventional pain specialists, radiologists, and anesthesiologists—are increasingly performing spinal decompressions under this code, sometimes with minimal surgical training. The existence of a standalone, nonspecific endoscopic code obscures the boundary between interventional and surgical disciplines. This dilution of professional identity is not merely economic—it raises patient safety and credentialing concerns. Endoscopic decompression is spine surgery, and spine surgery belongs within the domain of trained spine surgeons.

This contradiction has not gone unchallenged. The International Society for the Advancement of Spine Surgery, through its historic representation on the American Medical Association’s CPT️ Spine Workgroup, played a key role in establishing endoscopic visualization as equivalent to other forms of direct visualization. That foundational work led to CPT’s formal acknowledgment of endoscopy as “light-based, direct visualization.” However, the application of this principle remains inconsistently enforced, especially when it comes to reimbursement.

Attempts to fix this issue through tiered endoscopic codes may be well-intentioned, but such attempts risk entrenching a flawed foundation. Rather than erect a parallel universe of endoscopic codes, we should unify all decompression procedures under a single framework: define codes by the surgical work performed, not the tool used to visualize it. Whether the operation is performed through a tubular retractor, microscope, or endoscope, the true metric should be the extent and complexity of decompression, not the light source.

Recent Rasch analyses and paired psychometric surveys confirm that CPT code 62380 is routinely undervalued relative to the work intensity, learning curve, and psychological stress associated with endoscopic decompression.2,3 These findings reinforce the need for a paradigm shift: away from technology-delineated codes and toward value-based procedural equivalency.

The International Society for the Advancement of Spine Surgery has long championed innovation in spine surgery, but we must also be guardians of surgical truth. As we advocate for the future of endoscopic spine surgery, let us not get lost in hardware distinctions. Let us instead advocate for a coding system that rewards what matters most: the skill of the surgeon, the needs of the patient, and the integrity of the procedure.

In an era where minimally invasive techniques are reshaping surgical disciplines, it is not enough to push for technological legitimacy—we must also demand coding clarity. Retiring code 62380 may be the bold step needed to unify spine surgery under a model that reflects reality, not redundancy.

Reimbursement for spine surgery must account for the substantial variation in material costs associated with different procedural approaches. Endoscopic techniques, unlike traditional open surgeries, often depend on specialized high-cost disposable tools, such as single-use cannulae, trephines, radiofrequency probes, lasers, and fluid-integrated endoscopes. These items are not implantable and, therefore, fall outside the scope of conventional device-based reimbursement models. However, current coding frameworks—particularly CPT 62380—categorize all endoscopic lumbar decompression procedures under a single, global service code, offering no mechanism to capture differences in material intensity or intraoperative resource utilization. In contrast, open decompression and fusion procedures are reimbursed with greater specificity based on the number of levels treated, surgical approach, and implant usage. A more transparent and equitable reimbursement strategy could involve establishing a reporting mechanism—similar to C-codes but designed for disposables—that enables the Centers for Medicare and Medicaid Services and other payers to account for high-cost, nonimplantable technologies used in endoscopic spine surgery. Whether through CPT code stratification or the development of auxiliary coding systems, aligning reimbursement with actual resource consumption is critical to incentivizing efficiency and ensuring continued access to high-value, minimally invasive care. These economic distortions further reinforce the need for structural reform—not only in how we track costs but also in how we classify surgical work.

The solution is simple and principled: delete CPT 62380 and apply existing decompression codes based on surgical work performed—regardless of direct visualization method. This would restore equity, eliminate redundancy, and reinforce that surgical complexity, not scope type, defines value.

• This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2025 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.