In 2024, Medicaid providers in Scranton billed a total of $15,099,534 for Medicine Services and Procedures, as reported in the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 1.3% increase over 2023, when the same category saw $14,908,379 in claims.
Medicaid is a joint federal and state program that insures low-income families and individuals, seniors, children and people with disabilities, making it a key component of the U.S. health system. Funding comes from both federal and state governments as outlined here.
Because taxpayer dollars support Medicaid, shifts in billing levels at the community level illustrate how healthcare funds are spent locally.
The “Medicine Services and Procedures” category covers a set of Medicaid services grouped according to care type, using standard HCPCS and CPT coding conventions. All billing codes in this analysis were consistently assigned to one service category based on prefixes and number series, enabling service comparisons across years and reducing overlap or duplicate counts.
Although overall Medicaid spending grew in a number of service groups, Medicine Services and Procedures ranked as the third-largest category by total Medicaid payments in Scranton for 2024.
Statewide in Pennsylvania, Medicine Services and Procedures also ranked third in Medicaid payments for 2024.
From 2019 through 2024, Scranton experienced a $12,647,201, or 515.7%, increase in Medicaid payments for Medicine Services and Procedures. The fastest growth periods were during 2020 and 2021, with especially large annual increases.
Though this category of care was delivered throughout the city, much of the spending was concentrated in a small number of ZIP codes. In 2024, the largest amounts were billed in 18503 ($5,310,870), 18505 ($4,915,832), and 18509 ($2,168,597). Together, these top 3 ZIP codes represented 82.1% of all Medicaid payments linked to this category in Scranton for the year.
Within Medicine Services and Procedures, the majority of Medicaid payments were focused on a select group of billing codes.
Comparing year-over-year data, Medicaid payments for Medicine Services and Procedures in Scranton increased by 1.3% from 2023 to 2024. Across all Medicaid claim categories in Scranton, the period saw a 4.7% overall change.
The Centers for Medicare & Medicaid Services reports that combined federal and state Medicaid spending totaled approximately $871.7 billion in fiscal 2023, making up about 18% of national health costs, up from $613.5 billion in 2019 prior to the COVID-19 pandemic.
This roughly 40% growth occurred over just a few years, with the bulk of the increase attributed to expanded enrollment and higher service use during and after the pandemic.
Recent federal budget measures under the Trump administration have included notable efforts to reduce federal Medicaid funding and change the program’s structure. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to cut more than $1 trillion in federal Medicaid spending over 10 years, introducing work requirements and greater cost-sharing. These changes may reduce coverage and federal funding for some recipients, shifting more financial responsibility to state governments while the program continues covering tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $2,452,332 | 1249.1% |
| 2021 | $12,266,431 | 400.2% |
| 2022 | $13,539,653 | 10.4% |
| 2023 | $14,908,379 | 10.1% |
| 2024 | $15,099,534 | 1.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Temporary National Codes (Non-Medicare) | $35,085,241 | 35.9% |
| 2 | National Codes Established for State Medicaid Agencies | $26,932,768 | 27.5% |
| 3 | Medicine Services and Procedures | $15,099,534 | 15.4% |
| 4 | Evaluation and Management | $7,925,086 | 8.1% |
| 5 | Alcohol and Drug Abuse Treatment | $5,054,514 | 5.2% |
| 6 | Procedures / Professional Services | $3,580,075 | 3.7% |
| 7 | Dental Services | $1,386,865 | 1.4% |
| 8 | Vision Services | $957,254 | 1% |
| 9 | Pathology and Laboratory Procedures | $947,327 | 1% |
| 10 | Radiology Procedures | $523,253 | 0.5% |
| 11 | Durable Medical Equipment | $245,554 | 0.3% |
| 12 | Surgery | $35,010 | <0.1% |
| 13 | Temporary Codes | $17,644 | <0.1% |
| 14 | Medical And Surgical Supplies | $7,401 | <0.1% |
| 15 | Anesthesia | $4,217 | <0.1% |
| 16 | Drugs Administered Other than Oral Method | $2 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| 17 | Outpatient PPS | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 90834 | Psytx w pt 45 minutes | $4,624,902 | 103 |
| 97153 | Adaptive behavior tx by tech | $4,559,942 | 33 |
| 90853 | Group psychotherapy | $1,229,120 | 48 |
| 97155 | Adapt behavior tx phys/qhp | $929,235 | 33 |
| 90792 | Psych diag eval w/med srvcs | $836,067 | 26 |
| 90837 | Psytx w pt 60 minutes | $559,953 | 44 |
| 90832 | Psytx w pt 30 minutes | $303,257 | 37 |
| 92014 | Compre oph exam est pt 1/> | $235,506 | 74 |
| 97151 | Bhv id assmt by phys/qhp | $215,453 | 21 |
| 97110 | Therapeutic exercises | $175,566 | 117 |
| 90847 | Family psytx w/pt 50 min | $158,465 | 24 |
| 97530 | Therapeutic activities | $145,393 | 23 |
| 96372 | Ther/proph/diag inj sc/im | $114,454 | 126 |
| 96374 | Ther/proph/diag inj iv push | $94,243 | 146 |
| 97166 | Ot eval mod complex 45 min | $76,946 | 16 |
| 92507 | Tx sp lang voice comm indiv | $76,235 | 20 |
| 96131 | Psycl tst eval phys/qhp ea | $72,719 | 13 |
| 96130 | Psycl tst eval phys/qhp 1st | $52,684 | 12 |
| 92012 | Intrm oph exam est patient | $49,442 | 12 |
| 93306 | Tte w/doppler complete | $49,097 | 34 |
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.
