Medicaid providers in Monongahela submitted claims totaling $979,518 for Evaluation and Management services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents a 3.8% increase over 2023, when billings for these services reached $943,889.
Medicaid, a public health insurance program managed by states and funded jointly by federal and state governments, serves low-income individuals and families, older adults, children, and people with disabilities. It is one of the largest components of the U.S. health care system.
Since taxpayer dollars finance Medicaid, local shifts in billing reflect how public health funds are allocated within a community.
The Evaluation and Management category covers various Medicaid-funded health care services, identified by standardized HCPCS and CPT code groupings. This analysis assigned each billing code to one service category, using consistent code prefixes and numeric ranges to analyze related services collectively and avoid duplications, ensuring accurate comparisons over periods.
Evaluation and Management led all Medicaid payment categories in Monongahela in 2024 by total billed amount, amid growth in several service categories.
At the state level in Pennsylvania, Evaluation and Management ranked as the fourth largest by overall Medicaid payments in 2024.
From 2019 through 2024, Medicaid payments for Evaluation and Management services in Monongahela increased by $833,505, or 570.8%. Certain periods saw accelerated growth, including notable increases in 2021 and 2023.
Though the citywide spending on Evaluation and Management services was distributed geographically, payments concentrated in a small number of ZIP codes. In 2024, ZIP code 15063 accounted for $979,518 in Medicaid payments for these services. Altogether, the top ZIP code comprised 100% of all Evaluation and Management Medicaid spending in the city that year.
This category’s Medicaid reimbursements in Monongahela were focused among just a few billing codes.
Comparatively, Medicaid payments in Monongahela linked to Evaluation and Management grew by 3.8% from 2023 to 2024, outpacing a 3.2% citywide increase across all categories during the same timeframe.
According to the Centers for Medicare & Medicaid Services, state and federal Medicaid spending hit approximately $871.7 billion in fiscal year 2023, making up around 18% of total U.S. health expenditures, a significant rise from $613.5 billion in 2019 prior to the COVID-19 pandemic.
This increase—around 40% over a few years—is primarily attributed to greater enrollment and higher utilization during and after the pandemic.
Recent federal budgeting under the Trump administration included substantial proposals for decreased federal Medicaid funding and program restructuring. The “One Big Beautiful Bill Act,” signed in 2025, is expected to reduce federal Medicaid spending by more than $1 trillion in the next decade and implement policies such as work requirements and higher cost-sharing, potentially narrowing coverage and funding for some enrollees. These measures may increase costs for states and slow the expansion of federal Medicaid support, even as the program continues to be relied on by tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $146,012 | – |
| 2021 | $983,270 | 573.4% |
| 2022 | $767,997 | -21.9% |
| 2023 | $943,888 | 22.9% |
| 2024 | $979,518 | 3.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $979,518 | 47% |
| 2 | Durable Medical Equipment | $427,656 | 20.5% |
| 3 | Pathology and Laboratory Procedures | $212,700 | 10.2% |
| 4 | Medical And Surgical Supplies | $144,388 | 6.9% |
| 5 | Ambulance and Other Transport Services and Supplies | $109,336 | 5.3% |
| 6 | Medicine Services and Procedures | $79,199 | 3.8% |
| 7 | National Codes Established for State Medicaid Agencies | $60,425 | 2.9% |
| 8 | Radiology Procedures | $53,096 | 2.6% |
| 9 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $11,471 | 0.6% |
| 10 | Procedures / Professional Services | $3,948 | 0.2% |
| 11 | Surgery | $129 | <0.1% |
| 12 | Administrative, Miscellaneous and Investigational | $17 | <0.1% |
| 13 | Drugs Administered Other than Oral Method | $0 | <0.1% |
| 13 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99284 | Emergency dept visit mod mdm | $520,687 | 94 |
| 99283 | Emergency dept visit low mdm | $259,288 | 90 |
| 99214 | Office o/p est mod 30 min | $77,410 | 24 |
| 99285 | Emergency dept visit hi mdm | $35,377 | 10 |
| 99391 | Per pm reeval est pat infant | $32,189 | 20 |
| 99213 | Office o/p est low 20 min | $27,173 | 23 |
| 99392 | Prev visit est age 1-4 | $18,745 | 11 |
| 99393 | Prev visit est age 5-11 | $3,559 | 2 |
| 99188 | App topical fluoride varnish | $3,193 | 13 |
| 99394 | Prev visit est age 12-17 | $1,716 | 1 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $100 | 1 |
| 99223 | 1st hosp ip/obs high 75 | $80 | 1 |
| 99173 | Visual acuity screen | $0 | 1 |
| 99459 | Pelvic examination | $0 | 2 |
Note: HCPCS codes are shown for context within the category. Category totals and rankings in this article are based on standardized service groupings rather than individual billing codes.
Information in this article was obtained from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data can be found here.
