CPT Code 62380 is Broken — Here’s How We Might Fix It
Momentum is on endoscopic spine’s side — now it’s time for reimbursement to catch up.
Every great innovation in spine surgery eventually runs into the same wall: reimbursement.
Endoscopic spine has been gaining ground for over a decade. The tools are better. The cameras are clearer. The learning curve, while still steep, is now supported by robust training programs and real-world data. But one thing hasn’t evolved: the code that’s supposed to support it.
CPT 62380 — billed as “Endoscopic decompression of the spinal cord or nerve root(s)” — is broken. And until we fix it, endoscopic spine will remain stuck in pilot mode: widely proven, narrowly adopted.
Let’s explore why it’s broken — and walk through three hypothetical (but plausible) ways to rebuild it.
What CPT 62380 Was Supposed to Be
Introduced in 2017, CPT 62380 was designed to give endoscopic spine its own reimbursement pathway. On the surface, it sounds like progress — a clean, dedicated code, unburdened by the legacy of open techniques.
But the devil is in the details.
It’s limited to lumbar decompression.
It doesn’t account for complexity, levels, or instrumentation.
It’s vaguely defined, leading to inconsistent payer behavior and audit risk.
Facility payments are modest (~$4,000 in ASCs) and don’t scale.
That might have been sufficient when single-level lumbar decompression was the ceiling. But today, surgeons are performing multi-level cases, using interlaminar approaches, combining implants, and moving into thoracic and cervical regions. The code hasn’t kept up.
Why 62380 is a Bottleneck
Endoscopic spine isn’t just about a new tool. It’s about enabling a less invasive care pathway — one that avoids fusion, speeds up recovery, and allows more spine to be done safely in ASCs. But coding and payment policy have failed to recognize this shift.
Here’s what’s going wrong:
Flat Rate, Regardless of Complexity
A single-level decompression pays the same as a three-level procedure with facetectomy and implant placement. That’s not just misaligned — it’s disincentivizing.No Add-ons, No Support for Scaling
In contrast to TLIF/PLIF codes that support +22840 for instrumentation or +63035 for additional levels, 62380 has no such flexibility.Coding Confusion
Surgeons in private practice often default to 63030 (laminotomy) or 63047 (laminectomy) for fear that payers won’t understand or cover 62380 — defeating the point of having a dedicated code.
Three Hypothetical Fixes
Here’s how we might fix the code — and finally unlock the broader promise of endoscopic spine.
1. Expand 62380 with Add-On Codes
This is the most practical near-term fix. Keep 62380 as the base code, but add CPT-approved modifiers or dedicated add-on codes for:
Additional levels
Instrumentation
Cervical/thoracic regions
Pros:
✅ Preserves the current structure
✅ Scales with complexity
✅ Encourages cleaner documentation
Cons:
❌ Adds coding complexity
❌ Still relies on payer education
❌ CPT Editorial Panel approval is not guaranteed
2. Subdivide 62380 by Region and Approach
Take a page from open spine coding and break 62380 into an anatomical family of codes:
6238A: Lumbar endoscopic decompression
6238B: Thoracic endoscopic decompression
6238C: Cervical endoscopic decompression
Pros:
✅ More precise RVU assignment
✅ Easier to align with clinical indications
✅ Clarifies billing documentation
Cons:
❌ Could fragment utilization data
❌ May slow adoption of newer approaches (like thoracic or interlaminar)
❌ New codes still face payer lag
3. Migrate Toward a Bundled Payment Model
The boldest idea: replace 62380 entirely with a procedural bundle. Think of it like a DRG-lite for ASCs or a value-based pathway for hospitals.
Procedure Example:
Endoscopic decompression episode bundle
Includes pre-op imaging, decompression, sedation, implant (if applicable), and 90-day follow-up.
Pros:
✅ Aligns with CMS value-based priorities
✅ Promotes ASC migration
✅ De-risks overuse accusations
Cons:
❌ High startup complexity
❌ Requires surgeon/facility alignment
❌ Not viable for low-volume solo providers
What the Critics Will Say
Let’s address the obvious pushback:
“Why change what works? We already have a code.”
Sure — but it’s a code that surgeons are either afraid to use or forced to work around. That’s not success. That’s stagnation.
“These changes will take years.”
Yes. But if we don’t start now, we’ll still be having this conversation in 2030.
“Surgeons are just trying to game reimbursement.”
Wrong. Most are underpaid for complex cases and over-scrutinized for using a legitimate technique. Reform brings transparency — not exploitation.
The Bigger Picture
The promise of endoscopic spine has never been clinical alone — it’s economic. A tool that can reduce hospital stays, avoid fusion, and scale minimally invasive spine should be a centerpiece of modern spine strategy. But without reimbursement alignment, it stays niche.
Fixing 62380 isn’t just a CPT issue. It’s a growth unlock.
Closing Thought
CPT 62380 helped endoscopic spine enter the game but now, it could be holding the field back. In order for this specialty to scale, we need to build a smarter code — not just a smaller incision.