Purpose <p>The optimal treatment of radial head fractures remains debated, particularly in elderly populations. This study aimed to evaluate twenty-year trends in the management of radial head fractures and physician reimbursement patterns using Medicare claims data.</p> Methods <p>The study utilized the Medicare Part B National Summary Files to extract data for all Current Procedural Terminology (CPT) codes pertinent to radial head fractures. Data collected included physician reimbursement, utilization rates, and patient charges annually from 2000 to 2021. To ensure comparability, all financial figures were adjusted for inflation to reflect the values in the latest year on record, 2021.</p> Results <p>From 2000 to 2021, care for a total of 203,458 radial head fractures were billed to Medicare. After adjusting for Medicare enrollment growth, overall treatment rates decreased by 34%. Rates of nonoperative management declined by 40%, osteosynthesis (ORIF) by 55%, while radial head arthroplasty (RHA) increased by 247%. Nonoperative treatment remained the most common procedure in 2021 (10.5 per 100,000), followed by RHA (1.7 per 100,000), and ORIF (0.7 per 100,000). After adjusting financial data for inflation, average physician reimbursement increased by 22% across all radial head procedures.</p> Conclusion <p>This study summarized treatment trends for radial head fractures in the Medicare population. While the majority of RHFs continue to be managed nonoperatively, there has been a notable trend toward increased use of radial head arthroplasty (RHA) over open reduction internal fixation (ORIF) for operatively managed fractures. Physician reimbursement for operative treatment has risen for all procedures, with the greatest increase observed in RHA.</p>