Saxonburg sees 222.8% jump in Medicaid Evaluation and Management payments in 2024

In 2024, Medicaid providers based in Saxonburg billed a total of $7,157 for services falling within the Evaluation and Management category, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 222.8% increase over 2023, when billings for these services reached $2,217.

Medicaid is a government insurance program supported jointly by the federal government and states. It provides coverage to individuals and families with low income, as well as seniors, children, and people with disabilities, making it one of the core components of the U.S. health care system.

Since Medicaid is funded by taxpayers, variations in local billing illustrate how communities distribute public health care resources.

The “Evaluation and Management” category encompasses Medicaid services that are grouped according to the care delivered, using standardized HCPCS and CPT code classifications. For this analysis, each billing code was assigned to one service category using standardized prefixes and number ranges. This approach helps group related services, avoids double counting, and maintains consistent rankings over time.

While Medicaid expenditures increased across a variety of service categories, Evaluation and Management placed second in Saxonburg for overall Medicaid billings in 2024.

Across Pennsylvania, the Evaluation and Management category landed fourth in total state Medicaid payments during 2024.

Looking at the five-year span to 2024, Medicaid payments linked to the Evaluation and Management group in Saxonburg climbed by $7,157, an increase of 0%. There were periods of faster spending growth, with year-over-year gains notably recorded in 2023 and 2022.

Spending for Evaluation and Management services was reported throughout the area, but payments were concentrated in a few ZIP codes. In 2024, ZIP code 16056 accounted for $7,156 of the Medicaid total in this category. The top ZIP code was responsible for 100% of all related Medicaid billings in Saxonburg that year.

Medicaid spending within the Evaluation and Management group was narrowly distributed among a small set of individual billing codes.

Comparatively, payments for Evaluation and Management services in Saxonburg grew by 222.8% from 2023 to 2024. For all Medicaid billing categories in the city during the same window, the overall increase was 605.6%.

According to the Centers for Medicare & Medicaid Services, total federal and state spending on Medicaid was about $871.7 billion in fiscal year 2023, accounting for approximately 18% of all U.S. health care expenditures. That figure is substantially higher than the $613.5 billion billed in 2019, the year before the COVID-19 pandemic.

This marks an increase of around 40% over a few years, mainly driven by larger enrollment and greater use of services during and after the pandemic.

Recent federal courses of action under the Trump administration put forth wide-ranging proposals to limit and restructure federal Medicaid funding. The “One Big Beautiful Bill Act,” approved in 2025, calls for federal Medicaid cuts totaling more than $1 trillion over 10 years, plus policies such as work requirements and higher out-of-pocket costs. These changes could potentially reduce coverage and funding for certain enrollees, shifting additional financial responsibility to the states while federal dollars are curtailed, even as the program serves tens of millions.

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.