Objective: This study analyzed Medicare utilization and reimbursement trends for endoscopic discectomy and microdiscectomy from 2017 to 2021 to assess the adoption of endoscopic discectomy, the potential effect on microdiscectomy volume, and the impact of healthcare policy changes on these procedures. This analysis will help shape future economic reimbursement models for lumbar disc herniation surgeries. Methods: Medicare Part B data for endoscopic discectomy (Current Procedural Terminology [CPT] code 62380) and microdiscectomy (CPT code 63030) from 2017 to 2021 were analyzed. Long-term trends were reviewed using 2000–2016 microdiscectomy data. Total percent changes for procedural volume and mean reimbursement per procedure were evaluated, adjusting all financial figures to 2021 United States dollars using the Consumer Price Index. Trends were assessed using simple linear regression. Results: From 2017 to 2021, Medicare documented 2,344 endoscopic discectomies and 126,501 microdiscectomies. Endoscopic discectomy volume increased by 8.58%, while microdiscectomy volume decreased by 27.78%, with a significant declining trend (p=0.006). The negative trend in microdiscectomy volume trend from 2017 to 2021 reflected an ongoing decline from 2000 to 2021. The inflation-adjusted mean reimbursement per endoscopic discectomy decreased by 27.51%, whereas the mean reimbursement per microdiscectomy marginally increased by 1.54%. Conclusion Since the introduction of the endoscopic discectomy CPT code, endoscopic discectomy has had limited adoption and decreasing reimbursement, while microdiscectomy volume declined despite reimbursements aligning with inflation—a decrease not explained by increased endoscopic use. The alignment of microdiscectomy reimbursement with inflation has required repeated legislative interventions. Further research is essential to optimize future spinal surgery reimbursement strategies.