Evaluation and Management Medicaid claims total $470,960 in Roaring Spring for 2024

In 2024, Medicaid providers in Roaring Spring billed $470,960 for services under the Evaluation and Management category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents a 13.2% rise compared with 2023, when claims for these services totaled $416,152.

Medicaid is a public health insurance program, administered by the states and financed jointly by federal and state governments. It provides coverage for low-income individuals and families, seniors, children, and individuals with disabilities, making it one of the largest components of the U.S. health care system.

Because Medicaid is taxpayer-funded, shifts in local billing patterns indicate how health care dollars are allocated within the community.

The Evaluation and Management category includes Medicaid-billed services classified by the type of care provided, using standardized HCPCS and CPT code groupings. For this review, each billing code was mapped to a single service category based on consistent code prefixes and number ranges, enabling analysis of related services together, while avoiding double counting and maintaining accurate rankings across periods.

While several service categories saw increases in Medicaid spending, Evaluation and Management led all categories in Roaring Spring by total Medicaid payments in 2024.

Statewide, the Evaluation and Management category ranked fourth in total payments across Pennsylvania for 2024.

From 2019 through 2024, Medicaid payments associated with Evaluation and Management in Roaring Spring grew by $408,692, an increase of 656.3%. Certain periods experienced sharper growth, with significant annual increases recorded in 2020 and 2021.

Though Evaluation and Management care spending was distributed citywide, the bulk of payments was concentrated within a small number of ZIP codes. In 2024, ZIP code 16673 accounted for all Medicaid payments for Evaluation and Management in Roaring Spring, totaling $470,960. Altogether, this top ZIP code represented 100% of such Medicaid payments in the city for the year.

Within the Evaluation and Management group, Medicaid payments were primarily concentrated among a relatively small set of individual billing codes.

Comparatively, Evaluation and Management Medicaid payments in Roaring Spring rose by 13.2% from 2023 to 2024, compared with a 6.6% change for all Medicaid claim categories in the city over the same period.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending totaled about $871.7 billion in fiscal year 2023, representing roughly 18% of national health expenditures, up from approximately $613.5 billion in 2019, prior to the COVID-19 pandemic.

This growth amounts to an increase of around 40% over several years, largely due to expanded enrollment and increased utilization during and following the pandemic.

Recent federal budget legislation enacted during the Trump administration featured major proposals to cut federal Medicaid funding and restructure the program. For instance, the “One Big Beautiful Bill Act,” signed into law in 2025, is expected to reduce federal Medicaid expenditures by over $1 trillion over the next decade. The law includes provisions such as work requirements and more cost-sharing, which could result in less coverage and funding for some beneficiaries. These policies are likely to place more financial responsibility on states and restrict growth in federal Medicaid funding, even as the program continues covering tens of millions of Americans.

Note: HCPCS codes are provided for context within the category. Category totals and rankings used in this article are based on standardized service groupings, not individual billing codes.

Information in this article was sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data is available here.