Connellsville Medicaid outlays for medicine services total $3,300,235 in 2024

Dr. Mehmet Oz CMS Administrator
Dr. Mehmet Oz CMS Administrator
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In 2024, Connellsville Medicaid providers billed $3,300,235 for services listed under the Medicine Services and Procedures category, as reported in the U.S. Department of Health and Human Services Medicaid Provider Spending database. This reflects an increase of 0.1% from 2023, when claims for these services reached $3,297,939.

Medicaid operates as a health coverage option managed by individual states, but sharing funding between the federal and state governments. It supports low-income residents, older adults, children, and people living with disabilities, making it among the country’s largest health insurance programs.

Taxpayer contributions fund Medicaid payments, so variations in local billing highlight how publicly funded health care resources are distributed throughout a community.

The “Medicine Services and Procedures” category comprises a variety of Medicaid-billed services defined by the type of clinical work performed, organized by standardized HCPCS and CPT code groups. For analysis purposes, each billing code was attached to a singular service group using stable code sequences and numeric brackets. This approach makes it possible to assess groups of related procedures collectively, ensuring there is no double-counting and allowing consistent comparisons over time.

Spending grew across several Medicaid care categories, with Medicine Services and Procedures topping the list for total Medicaid payments in Connellsville for 2024.

In Pennsylvania overall, Medicine Services and Procedures placed third by payment total within Medicaid categories in 2024.

Over the five years before 2024, Connellsville Medicaid payments in the Medicine Services and Procedures category rose by $3,054,848, a gain of 1244.9%. Some years—including 2020 and 2021—witnessed pronounced annual growth.

While care costs in this category were dispersed throughout the city, the majority of payments came from a handful of ZIP codes. In particular, ZIP code 15425 led with $3,300,234, comprising 100% of the citywide Medicaid costs in this category for 2024.

Medicaid outlays within Medicine Services and Procedures further focused on only a few core billing codes.

For additional perspective, the 0.1% year-over-year rise for this category trailed the 3.1% increase seen across all categories of Medicaid claims in Connellsville in that period.

The Centers for Medicare & Medicaid Services states total federal and state Medicaid expenditures hit approximately $871.7 billion in fiscal 2023, accounting for close to 18% of all U.S. health care spending—a steep rise from as low as $613.5 billion in 2019, prior to the COVID-19 pandemic.

The roughly 40% increase in that span is mainly attributed to spikes in enrollment and utilization in the years during and following the pandemic.

Top-line federal budget measures enacted during the Trump administration introduced notable proposals aimed at scaling back federal Medicaid contributions and reworking the program. The “One Big Beautiful Bill Act,” for example, which became law in 2025, is projected to slash federal Medicaid spending by more than $1 trillion in the next 10 years, and establishes new requirements such as work mandates and greater cost-sharing that could restrict coverage and funding for some enrollees. These measures are expected to push more responsibility onto states and constrain federal Medicaid spending growth, though the program will continue to serve tens of millions nationwide.

Medicaid Payments Tied to Medicine Services and Procedures in Connellsville, Pennsylvania Over Five Years

Year Total Medicaid Payments % Change From Previous Year
2020 $245,387 3221.7%
2021 $2,034,364 729%
2022 $2,646,282 30.1%
2023 $3,297,938 24.6%
2024 $3,300,234 0.1%
Top Categories by Medicaid Payments in Connellsville, Pennsylvania, 2024

Rank Category Medicaid Payments Share of City Total
1 Medicine Services and Procedures $3,300,234 39.9%
2 Ambulance and Other Transport Services and Supplies $3,089,648 37.3%
3 Alcohol and Drug Abuse Treatment $924,398 11.2%
4 National Codes Established for State Medicaid Agencies $265,744 3.2%
5 Evaluation and Management $263,928 3.2%
6 Pathology and Laboratory Procedures $170,509 2.1%
7 Procedures / Professional Services $116,297 1.4%
8 Durable Medical Equipment $69,731 0.8%
9 Vision Services $62,101 0.8%
10 Medical And Surgical Supplies $7,794 0.1%
11 Durable medical equipment (DME) Medicare administrative contractors (MACs) $6,143 0.1%
12 Dental Services $2,068 <0.1%
13 Radiology Procedures $1,437 <0.1%
14 Drugs Administered Other than Oral Method $0 <0.1%
14 Surgery $0 <0.1%
14 Temporary Codes $0 <0.1%
Top 20 HCPCS Codes Within the Medicine Services and Procedures Category in Connellsville, Pennsylvania, 2024

HCPCS Code Description Medicaid Payments Claims
97153 Adaptive behavior tx by tech $1,180,096 20
90834 Psytx w pt 45 minutes $912,661 25
97155 Adapt behavior tx phys/qhp $509,506 24
97151 Bhv id assmt by phys/qhp $334,886 23
90792 Psych diag eval w/med srvcs $197,112 12
90837 Psytx w pt 60 minutes $109,979 12
97156 Fam adapt bhv tx gdn phy/qhp $32,921 13
96156 Hlth bhv assmt/reassessment $7,963 9
96365 Ther/proph/diag iv inf init $4,127 4
90832 Psytx w pt 30 minutes $3,650 4
96374 Ther/proph/diag inj iv push $1,864 5
96372 Ther/proph/diag inj sc/im $1,724 5
92015 Determine refractive state $1,260 2
93005 Electrocardiogram tracing $999 9
92014 Compre oph exam est pt 1/> $725 1
96375 Tx/pro/dx inj new drug addon $586 3
92552 Pure tone audiometry air $159 8
96160 Pt-focused hlth risk assmt $7 2
94760 N-invas ear/pls oximetry 1 $1 3
90460 Im admin 1st/only component $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.



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