In 2024, Medicaid providers in Carbondale submitted $22,158,238 in claims for services in the Medicine Services and Procedures category, according to figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This reflected a 65.6% rise over the $13,377,249 in such claims reported for 2023.
Medicaid, a state-administered public health insurance program jointly funded by federal and state governments, provides coverage for low-income people, families, seniors, children, and individuals with disabilities and remains a major component of the U.S. health care system.
Since Medicaid is taxpayer-funded, variations in local billing volumes illustrate how public health funds are distributed within a community.
The “Medicine Services and Procedures” category represents a collection of Medicaid services defined by care type using standardized HCPCS and CPT coding. For this report, each billing code was assigned to a specific service group based on its code prefix and range, allowing an accurate review of related services by year without double counting and maintaining consistent ranking.
While Medicaid expenditures grew in several categories, Medicine Services and Procedures recorded the highest payment total among all Medicaid services in Carbondale for 2024.
A statewide view places Medicine Services and Procedures as the third-largest category by Medicaid payments in Pennsylvania in 2024.
Over the five years preceding 2024, Carbondale’s Medicaid payments for the Medicine Services and Procedures group grew by $22,000,455, a 13943.5% increase. The pace of this jump accelerated in certain periods, particularly with strong year-over-year gains seen in 2021 and 2022.
Medicaid expenditures for this care type were citywide, but mostly concentrated in specific ZIP codes. In 2024, claims from ZIP code 18407 accounted for all $22,158,238 of Medicaid payments attributed to Medicine Services and Procedures. Altogether, the top 1 ZIP code represented 100% of category spending in Carbondale for the year.
Among Medicine Services and Procedures, payments were further pooled around a limited number of specific billing codes.
When comparing categories, Medicaid payments for Medicine Services and Procedures in Carbondale rose 65.6% from 2023 to 2024, which is close to the 64.5% change posted across all Medicaid claims citywide over the same time period.
Data from the Centers for Medicare & Medicaid Services show that joint federal and state Medicaid spending reached about $871.7 billion for fiscal year 2023, nearly 18% of total national health expenses, up from more than $613.5 billion in 2019 (pre-pandemic).
This increase amounts to roughly 40% growth over a few years, primarily due to higher enrollment and utilization during and following the COVID-19 pandemic.
Recent federal budget measures during the Trump administration have included large-scale proposals to reduce federal Medicaid funding and redesign the program structure. Notably, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid expenditures by over $1 trillion in the next decade. The law also expands work requirements and raises cost-sharing, factors that may decrease beneficiary coverage and federal funding, shifting costs to states despite ongoing demand across the U.S.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $157,782 | – |
| 2021 | $2,207,508 | 1299.1% |
| 2022 | $9,071,402 | 310.9% |
| 2023 | $13,377,248 | 47.5% |
| 2024 | $22,158,238 | 65.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Medicine Services and Procedures | $22,158,238 | 89.6% |
| 2 | National Codes Established for State Medicaid Agencies | $2,052,654 | 8.3% |
| 3 | Ambulance and Other Transport Services and Supplies | $231,936 | 0.9% |
| 4 | Alcohol and Drug Abuse Treatment | $177,030 | 0.7% |
| 5 | Evaluation and Management | $82,721 | 0.3% |
| 6 | Procedures / Professional Services | $13,518 | 0.1% |
| 7 | Surgery | $1,953 | <0.1% |
| 8 | Pathology and Laboratory Procedures | $30 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 97153 | Adaptive behavior tx by tech | $15,337,437 | 31 |
| 97155 | Adapt behavior tx phys/qhp | $5,237,118 | 32 |
| 97151 | Bhv id assmt by phys/qhp | $1,267,819 | 24 |
| 97156 | Fam adapt bhv tx gdn phy/qhp | $273,945 | 23 |
| 92507 | Tx sp lang voice comm indiv | $41,917 | 7 |
| 90471 | Immunization admin | $0 | 3 |
| 90633 | Hepa vacc ped/adol 2 dose im | $0 | 1 |
| 90647 | Hib prp-omp vacc 3 dose im | $0 | 5 |
| 90651 | 9vhpv vaccine 2/3 dose im | $0 | 1 |
| 90656 | Iiv3 vacc no prsv 0.5 ml im | $0 | 6 |
| 90671 | Pcv15 vaccine im | $0 | 5 |
| 90710 | Mmrv vaccine sc | $0 | 2 |
| 90723 | Dtap-hep b-ipv vaccine im | $0 | 2 |
| 90734 | Menacwyd/menacwycrm vacc im | $0 | 1 |
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.
