Brodheadsville’s Medicaid payments for Evaluation and Management rise 27.3% to $215,134 in 2024

In 2024, Medicaid providers in Brodheadsville billed a total of $215,134 for services included in the Evaluation and Management category, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total reflected an increase of 27.3% compared with the prior year, when the same category of claims reached $168,983.

Medicaid, a state-operated health insurance program, is supported by a combination of federal and state government funding. It provides coverage for low-income individuals and families, children, seniors and people with disabilities, ranking as one of the most significant components of the U.S. health care system.

Since Medicaid relies on taxpayer funding, adjustments in local claims reflect how community health resources are distributed.

The Evaluation and Management designation covers a range of Medicaid-billed services grouped by the type of clinical care provided, determined by standard HCPCS and CPT code systems. This review categorizes each billing code into only one service group, using uniform prefixes and numerical codes, allowing grouped services to be tracked without overlap and to enable accurate comparisons over time.

Among all Medicaid service categories in Brodheadsville, Evaluation and Management led in total payment amount for 2024.

Statewide across Pennsylvania, Evaluation and Management ranked fourth in total Medicaid payments in 2024.

Within the five years prior to 2024, Brodheadsville’s Medicaid payments for Evaluation and Management services grew by $194,102, a 922.9% gain. Growth trends accelerated notably during 2020 and 2021, with sharper year-over-year increases.

While this spending was spread throughout Brodheadsville, payments were primarily concentrated in a small set of ZIP codes. For 2024, ZIP code 18322 accounted for $215,133, amounting to all Medicaid payments for this category in the city that year.

Within the category, Medicaid payments showed even greater focus among only a few specific billing codes.

Comparing the most recent years, Medicaid Evaluation and Management payments grew by 27.3% from 2023 to 2024 in Brodheadsville, compared to an overall citywide Medicaid claim increase of 23.4% across all categories over the same span.

According to the Centers for Medicare & Medicaid Services, federal and state spending on Medicaid reached approximately $871.7 billion for fiscal 2023, which was about 18% of total U.S. health expenditures and reflected a sharp rise from roughly $613.5 billion in 2019, before the COVID-19 pandemic.

This period represents an increase of about 40%, stemming mainly from higher enrollment and expanded service use during and after the pandemic era.

Federal budget changes introduced under the Trump administration have brought major plans to limit federal Medicaid aid. As an example, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid spending by over $1 trillion in the next 10 years, with new rules such as work requirements and greater cost-sharing that could affect coverage and funding for select enrollees. These moves are projected to shift further costs onto states and could put limits on rises in federal Medicaid funding, even as the program remains pivotal for millions of people.

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.