In 2024, Medicaid providers in Nesquehoning billed $609 for services in the Pathology and Laboratory Procedures category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. That amount was up 37.2% from 2023, when $444 in claims were filed for similar services.
Medicaid, administered by each state with funding from both federal and state governments, covers individuals and families with low incomes, as well as seniors, children, and people with disabilities. It is a major component of the U.S. health care system.
Because Medicaid is taxpayer funded, variations in local billing reflect how public health care resources are distributed within a community.
The “Pathology and Laboratory Procedures” category includes a range of Medicaid-billed services grouped by care type, based on HCPCS and CPT coding standards. For this reporting, each billing code was assigned to one service category using uniform code ranges and prefixes, which grouped related services for analysis while avoiding duplicate counting and maintaining accurate yearly rankings.
Medicaid expenditures rose in multiple service groups, with Pathology and Laboratory Procedures holding the second spot in Nesquehoning for total Medicaid payments in 2024.
At the state level in Pennsylvania, this category placed ninth in overall Medicaid payments for 2024.
Between 2020 and 2024, Medicaid payments for Pathology and Laboratory Procedures in Nesquehoning rose by $609, showing no percentage change over that span. Some years saw faster growth, with notable annual gains in both 2022 and 2023.
Payments in this category were distributed throughout the city but were concentrated in a small number of ZIP codes. In 2024, ZIP code 18240 accounted for $608, representing 100% of all Medicaid payments in this category in Nesquehoning for the year.
Within this service group, most Medicaid payments went to a limited number of individual billing codes.
Between 2023 and 2024, Nesquehoning Medicaid payments linked to this category rose by 37.2%, compared with an 88.1% change across all Medicaid claim categories in the city during the same timeframe.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached about $871.7 billion in fiscal 2023, making up around 18% of national health expenditures—a sharp increase from the $613.5 billion spent in 2019, ahead of the COVID-19 pandemic period.
This growth, about 40% in a few years, reflects higher enrollment and increased service use during and after the pandemic.
Recent federal budget legislation adopted under the Trump administration has included significant proposals to limit federal Medicaid spending and modify the program. The “One Big Beautiful Bill Act,” passed in 2025, is projected to cut more than $1 trillion from federal Medicaid expenditures over the next 10 years and introduces policy changes such as work requirements and greater cost-sharing. These measures are expected to shift more costs to the states and restrict the rate of federal Medicaid growth, even as millions of Americans remain enrolled in the program.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2023 | $444 | – |
| 2024 | $608 | 37.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $24,241 | 96.8% |
| 2 | Pathology and Laboratory Procedures | $608 | 2.4% |
| 3 | Medicine Services and Procedures | $204 | 0.8% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 87811 | Sars-cov-2 covid19 w/optic | $328 | 2 |
| 87804 | Influenza assay w/optic | $280 | 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.
