Tyrone Medicaid payments for evaluation and management services up 17.7% in 2024

In 2024, Medicaid providers in Tyrone billed $296,550 for services identified under the Evaluation and Management category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 17.7% rise from 2023, when $251,887 in claims were submitted for the same service grouping.

Medicaid, a public health program managed by the states and funded jointly by federal and state governments, covers low-income individuals and families, seniors, children, and those with disabilities, making it one of the nation’s largest health care programs.

Because Medicaid dollars originate from taxpayers, fluctuations in local billing show how public health funding is distributed within a community.

The “Evaluation and Management” category encompasses a specific group of Medicaid-billed services determined by the type of care provided, aligned with standardized HCPCS and CPT code groupings. For this report, each billing code was linked to a single service group using uniform code prefixes and number ranges, ensuring consistent analysis and avoiding duplicate counts or ranking errors over time.

Though Medicaid spending increased in several service categories, Evaluation and Management placed second by total Medicaid payments in Tyrone for 2024.

Statewide in Pennsylvania, Evaluation and Management was the fourth highest category by total Medicaid payments in 2024.

Over the five years preceding 2024, Medicaid payments associated with Evaluation and Management in Tyrone grew by $264,791, or 833.8%. This growth was especially notable in certain years, particularly with large annual increases in 2021 and 2022.

Payments for Evaluation and Management services were distributed citywide but were primarily concentrated in a small number of ZIP codes. In 2024, ZIP code 16686 accounted for $296,550, representing 100% of payments tied to this category in Tyrone for the year.

Within this category, Medicaid funds were mainly focused around a limited set of individual billing codes.

For further context, Medicaid payments related to Evaluation and Management in Tyrone increased by 17.7% between 2024 and 2023, while overall Medicaid spending in the city across all claim groups rose by 4.3% in the same period.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid expenditures totaled approximately $871.7 billion in fiscal year 2023, making up around 18% of total national health care spending, substantially higher than about $613.5 billion in 2019, before the COVID-19 pandemic.

This increase reflects nearly 40% growth over just a few years, driven largely by greater enrollment and higher utilization rates during and following the pandemic.

Recent federal budget measures enacted during the Trump administration include major proposals to curb federal Medicaid support and adjust program structure. The “One Big Beautiful Bill Act,” passed into law in 2025, is anticipated to reduce federal Medicaid funding by over $1 trillion over a decade and implements policies such as work requirements and increased cost-sharing that may reduce funding and coverage for some participants. These policies are expected to shift more expense to the states and limit future federal Medicaid growth, while the program continues covering tens of millions of Americans.

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.