In 2024, Medicaid providers in Monroeville billed $3,484,625 for services categorized as Procedures / Professional Services, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents an 82.8% increase from 2023, when providers recorded $1,906,555 in claims for the same service category.
Medicaid, a state-administered health insurance plan jointly funded by federal and state governments, provides coverage to low-income people, seniors, children, and individuals with disabilities. It is one of the largest health care programs in the United States.
Because taxpayer dollars fund Medicaid, changes in billing levels locally provide insight into how community health resources are distributed.
The Procedures / Professional Services designation encompasses a collection of Medicaid-billed treatments, determined by specific HCPCS and CPT code groupings. For this analysis, codes were assigned uniquely to a single service group using consistent code prefixes and numeric ranges, which helps group related services together and avoids duplicated counts or inaccuracies in year-to-year rankings.
Although spending rose in various Medicaid categories, Procedures / Professional Services was the third-highest by total Medicaid payments in Monroeville for 2024.
Statewide, in Pennsylvania, Procedures / Professional Services ranked fifth by total Medicaid reimbursements for 2024.
From 2019 to 2024, Medicaid payments in this category in Monroeville grew by $3,129,021, an increase of 879.9%. Spending growth picked up at certain intervals, with especially sharp year-over-year gains in 2020 and 2021.
While payments were made across Monroeville, the majority were concentrated in just a few ZIP codes. In 2024, ZIP code 15146 accounted for $3,484,624 in Medicaid reimbursements within the Procedures / Professional Services category. Overall, the top 1 ZIP code represented 100% of Medicaid payments for this category in the city during 2024.
Payments within the Procedures / Professional Services category were also clustered among a limited set of billing codes.
By comparison, Monroeville experienced an 82.8% increase in Medicaid payments for Procedures / Professional Services between 2024 and 2023, while overall Medicaid claim payments in the city rose by 20.4% in the same time frame.
Centers for Medicare & Medicaid Services reports that total federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023, making up roughly 18% of the nation’s health expenses—an increase from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This amounts to around 40% growth in just several years, attributed mainly to expanded participant numbers and greater usage during and following the pandemic period.
Recent federal budget laws during the Trump administration introduced major proposals to reduce federal Medicaid funding and reorganize the program. The “One Big Beautiful Bill Act,” signed in 2025, is anticipated to roll back over $1 trillion in federal Medicaid support over 10 years, and it includes provisions for work requirements and more cost-sharing—potentially limiting coverage and funding for some groups. These adjustments are expected to place more of the program’s financial burden on states and slow federal Medicaid growth, though the program remains a mainstay for millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $355,604 | 4299.6% |
| 2021 | $1,478,825 | 315.9% |
| 2022 | $708,103 | -52.1% |
| 2023 | $1,906,554 | 169.2% |
| 2024 | $3,484,624 | 82.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Drugs Administered Other than Oral Method | $32,197,436 | 54.1% |
| 2 | National Codes Established for State Medicaid Agencies | $14,767,992 | 24.8% |
| 3 | Procedures / Professional Services | $3,484,624 | 5.9% |
| 4 | Evaluation and Management | $2,535,968 | 4.3% |
| 5 | Alcohol and Drug Abuse Treatment | $1,991,879 | 3.3% |
| 6 | Temporary Codes | $1,843,214 | 3.1% |
| 7 | Medicine Services and Procedures | $1,115,086 | 1.9% |
| 8 | Durable Medical Equipment | $489,728 | 0.8% |
| 9 | Ambulance and Other Transport Services and Supplies | $410,053 | 0.7% |
| 10 | Pathology and Laboratory Procedures | $236,131 | 0.4% |
| 11 | Vision Services | $158,160 | 0.3% |
| 12 | Surgery | $87,474 | 0.1% |
| 13 | Medical And Surgical Supplies | $68,997 | 0.1% |
| 14 | Temporary National Codes (Non-Medicare) | $64,459 | 0.1% |
| 15 | Radiology Procedures | $47,470 | 0.1% |
| 16 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $20,628 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| 17 | Outpatient PPS | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| G0156 | Hhcp-svs of aide,ea 15 min | $2,438,667 | 12 |
| G0378 | Hospital observation per hr | $412,361 | 17 |
| G9012 | Other specified case mgmt | $316,039 | 12 |
| G0299 | Hhs/hospice of rn ea 15 min | $199,760 | 12 |
| G0151 | Hhcp-serv of pt,ea 15 min | $91,687 | 12 |
| G0152 | Hhcp-serv of ot,ea 15 min | $26,109 | 7 |
| G9920 | Scrning perf and negative | $0 | 9 |
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.
