Medicare Conversion Factor and Radiologist Activity: Associations With Beneficiary Volume and Per-Beneficiary Utilization

Medicare reimbursement is a key determinant of radiology practice, with the Medicare Physician Fee Schedule (MPFS) conversion factor directly influencing payment per Relative Value Unit (RVU). This study examines associations between the annual conversion factor and measures of diagnostic radiologist activity. Using 2013-2023 CMS Medicare provider-level data, we constructed a panel of diagnostic radiologists and analyzed trends in beneficiary volume, services, RVUs, and reimbursement within an interquartile range (IQR)-defined cohort. RVUs and allowed charges per beneficiary increased overall during the study period, although allowed charges peaked in 2020, declined in 2021 and 2022, and increased slightly in 2023. Correlation analysis demonstrated a positive association between the conversion factor and beneficiary volume (r r = = 0.44) and inverse associations with RVUs (r = -0.48) and services (r = -0.35) per beneficiary. Correlations with allowed charges and payments per beneficiary were near zero. These descriptive associations may reflect changes in imaging utilization and procedure mix, including a possible shift toward higher RVU services, but do not establish that radiologists changed their behavior in response to payment rates.