Ambridge Medicaid spending on evaluation and management services more than doubled in 2024

Ambridge Medicaid providers submitted $85,523 in 2024 for Evaluation and Management services, U.S. Department of Health and Human Services Medicaid Provider Spending data show. The amount represented a 111.3% jump from 2023, when claims for the category totaled $40,471.

Medicaid, a public health insurance initiative managed by states and funded together by federal and state governments, covers low-income families and individuals as well as seniors, children, and those with disabilities. It stands as a major component of the U.S. health care system.

Since taxpayer dollars finance Medicaid, variations in local billing indicate shifts in how public health care money is being used in a community.

The “Evaluation and Management” classification includes Medicaid-billed services related to types of care provided, grouped using standardized HCPCS and CPT code prefixes and numbers. Each billing code in this analysis was matched to one service category, enabling grouped services to be tracked over time and double counting to be avoided for accurate ranking.

While additional service categories also saw higher Medicaid spending, Evaluation and Management placed second by Ambridge’s total Medicaid payments in 2024.

Statewide in Pennsylvania, Evaluation and Management ranked fourth among all categories for Medicaid payments during 2024.

Over the five years through 2024, Ambridge’s Medicaid payments for Evaluation and Management surged by $83,836, a gain of 4,969.5%. Spending rose especially quickly during some periods, with notable annual increases reported in 2021 and 2022.

Within Ambridge, while Evaluation and Management spending spread across the city, the payments were highly focused in a few ZIP codes. In 2024, payments for the category in ZIP code 15003 came to $85,522. This single ZIP code made up 100% of all Ambridge Medicaid Evaluation and Management payments for that year.

Among the Evaluation and Management category, payments were further concentrated within a small set of individual billing codes.

For additional context, Ambridge Medicaid spending on Evaluation and Management grew by 111.3% from 2023 to 2024, compared to an 8.3% change across all Medicaid claim categories in the city in that time.

Centers for Medicare & Medicaid Services reported combined federal and state Medicaid outlays reached about $871.7 billion in fiscal 2023, making up approximately 18% of all national health spending. This reflects a substantial increase from $613.5 billion in 2019, before the COVID-19 pandemic.

This jump shows around 40% expansion within a few years, largely attributed to higher enrollment and rising service utilization during and after the pandemic.

Recent federal spending measures passed under the Trump administration included major proposals to reduce federal Medicaid support and restructure program requirements. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to slash federal Medicaid funds by over $1 trillion over the next decade. It introduces policy changes such as work requirements and steeper cost-sharing, potentially narrowing coverage for some enrollees and shifting financial responsibility to states. These policies could slow federal Medicaid funding growth, even as the program continues to insure 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.