Scranton Medicaid providers charged $26,932,769 for services within the National Codes Established for State Medicaid Agencies category during 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 1.7% increase from 2023, when providers reported $26,479,559 in claims for the same set of services.
Medicaid, a public health insurance system administered by states and funded through a federal-state partnership, serves low-income groups, seniors, children, and those with disabilities, making it one of the nation’s largest health care programs.
Since Medicaid payments are supported by taxpayers, fluctuations in local spending reflect how public health care resources are directed within a particular community.
The “National Codes Established for State Medicaid Agencies” classification covers a set of Medicaid-billed services grouped by care type, based on standardized HCPCS and CPT code prefixes and ranges. Each billing code in this review was classified into a single service group to allow related services to be analyzed together, thereby preventing double counting and maintaining consistent rankings over time.
While Medicaid spending rose across several service types, National Codes Established for State Medicaid Agencies was the second-largest Medicaid payment category in Scranton in 2024.
On a statewide level, National Codes Established for State Medicaid Agencies also held the No. 2 rank among Medicaid payment categories in Pennsylvania in 2024.
In the five years prior to 2024, Scranton’s Medicaid payments associated with National Codes Established for State Medicaid Agencies increased by $1,789,813, or 7.1%. Periods of accelerated growth included notable year-over-year gains in 2020 and 2023.
Though spending in the National Codes Established for State Medicaid Agencies category occurred citywide, most payments were concentrated in a few ZIP codes. In 2024, ZIP code 18505 accounted for $23,253,633; ZIP code 18509 had $2,907,147; and ZIP code 18503 captured $640,172. Altogether, these top 3 ZIP codes made up 99.5% of all Medicaid payments under this category in Scranton for the year.
Within the National Codes Established for State Medicaid Agencies group, payments were similarly focused on a smaller set of individual billing codes.
To compare, payments in this category in Scranton grew by 1.7% between 2024 and 2023, in contrast to a 4.7% increase across all Medicaid categories in the city during the same period.
Centers for Medicare & Medicaid Services data indicate combined federal and state Medicaid expenditures reached an estimated $871.7 billion in fiscal year 2023, comprising about 18% of all U.S. health spending, up sharply from roughly $613.5 billion in 2019, before the COVID-19 pandemic.
This rise marks a roughly 40% increase over a few years, primarily due to greater enrollment and increased utilization during and after the pandemic period.
Recent federal budget measures passed during the Trump administration included substantial proposals to reduce federal Medicaid assistance and modify the program structure. Notably, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid expenditures by more than $1 trillion in the next 10 years, with new policies such as work requirements and greater cost-sharing that could affect coverage and funding for some enrollees. The changes are set to place more financial responsibility on states and further limit federal Medicaid expansion, though the program continues to serve tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $25,142,955 | 63.3% |
| 2021 | $27,761,465 | 10.4% |
| 2022 | $23,848,362 | -14.1% |
| 2023 | $26,479,558 | 11% |
| 2024 | $26,932,768 | 1.7% |
| 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 |
|---|---|---|---|
| T1015 | Clinic service | $22,140,537 | 177 |
| T1017 | Targeted case management | $2,395,194 | 24 |
| T1002 | Rn services up to 15 minutes | $1,663,702 | 11 |
| T1016 | Case management | $616,185 | 33 |
| T1001 | Nursing assessment/evaluatn | $59,423 | 12 |
| T4543 | Adult disp brief/diap abv xl | $38,881 | 9 |
| T2023 | Targeted case mgmt per month | $18,296 | 4 |
| T4541 | Large disposable underpad | $547 | 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.
