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National Radiology Fee Schedule Conversion Factors by State

  • 1.  National Radiology Fee Schedule Conversion Factors by State

    Posted 12-30-2024 19:52
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    Below is a table (link) showing the Minimum, Average, and Maximum Conversion Factors by State for Medicare -26 services provided in facilities (e.g., hospitals) by radiologists in 2022. This analysis is based on the Medicare Physician & Other Practitioners by Provider dataset, which includes detailed information such as quantity, payment, and submitted charges by CPT code and provider (including NPI, name, and billing address).

    For this table, I calculated conversion factors by billing address (city, street, zip) and then aggregated them to the state level, weighted by procedure volume. The data incorporates RVU details from the Medicare RVU tables, which were added to the database for this analysis.

    Highlights:

    • Wisconsin radiologists had the highest average conversion factor (9.4 x Medicare Allowable).
    • South Dakota radiologists had the lowest average conversion factor (3.6 x Medicare Allowable).
    • Aggregated billing addresses that had less than $5,000 submitted charges in 2022 were excluded to improve data quality.
    • The analysis covered 54,995,000+ claims and over $149.5 million in Medicare payments.

    This dataset is incredibly versatile, allowing for analysis at a highly granular level-for example, CPT codes, procedure quantities, and submitted charges.

    If you'd like to explore the dataset, you can find it here: Centers for Medicare & Medicaid Services Data.

    A Word of Caution:

    The dataset is massive-over 480 MB zipped, containing 10+ million records with 29 data elements per record. Traditional tools like MS Access and Excel may struggle to handle its size effectively. Advanced database software or tools are recommended for analysis.



    ------------------------------
    Michael Bohl FRBMA
    Retired
    Radiology Group, PC, SC
    Bettendorf IA
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