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BACKGROUND CONTEXT Bundled payment models require risk adjustment to ensure appropriate targets are set. While this may be standardized for many services, spine fusions demonstrate significant variability in approach, invasiveness, and use of implants, that may require further risk adjustment. PURPOSE To evaluate variability in costs of spinal fusion episodes in a private insurer bundle payment program and identify whether current procedural terminology (CPT) code modifications are necessary for sustainable implementation. STUDY DESIGN/SETTING Retrospective single-institution cohort study. PATIENT SAMPLE A total of 542 lumbar fusion episodes in a private insurer bundled payment program from October 2018 to December 2020. OUTCOME MEASURES A total of 120-day episode of care net surplus/deficit, 90-day readmissions, discharge disposition, and length of hospital stay. METHODS A …