Medicaid payments for surgery in Madison climb 1.7% in 2024

In 2024, Medicaid providers in Madison billed $330,098 for services falling under the Surgery category, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 1.7% rise compared to 2023, when providers submitted $324,530 in claims for comparable services.

Medicaid is a state-administered public health insurance program funded by both federal and state governments. It provides coverage to low-income people, families, children, seniors, and individuals with disabilities, making it a major component of the U.S. health care landscape.

As Medicaid dollars are taxpayer-funded, changes in local billing reflect how a community distributes public health resources.

The “Surgery” classification groups Medicaid-billed services based on care type, using standardized HCPCS and CPT coding systems. This analysis assigned each billing code to one service group using specific code ranges and prefixes, allowing for consistent comparisons and avoiding double counting in rankings across time.

Although several Medicaid service categories saw expense increases, Surgery ranked as the fifth largest in Madison by total Medicaid payments during 2024.

For broader context, the Surgery category was ranked 11th statewide in West Virginia by total Medicaid payments that year.

Looking over the five-year period before 2024, Medicaid payments tied to Surgery in Madison grew by $89,914, which equates to a 37.4% rise. Spending accelerated at certain points, with particularly significant year-to-year increases in 2022 and 2023.

While Surgery-related Medicaid spending occurred citywide, most payments were concentrated in a small subset of ZIP codes. In 2024, ZIP code 25130 saw the highest Surgery category payments, totaling $330,098. The top single ZIP code represented 100% of Medicaid Surgery category payments in Madison for that year.

Payments for Surgery under Medicaid were also focused on fewer individual billing codes within the category.

Comparatively, Surgery payments in Madison increased 1.7% from 2023 to 2024; for all Medicaid claim categories in the city, the increase was 27% during the same time frame.

Data from the Centers for Medicare & Medicaid Services show that combined federal and state Medicaid expenditures reached about $871.7 billion in fiscal year 2023, making up roughly 18% of overall U.S. health spending—a sharp rise from the $613.5 billion in 2019, before the COVID-19 pandemic.

This constitutes approximately 40% growth in just a few years, which was propelled largely by more enrollees and increased use of services in and after the pandemic.

Recent federal budget measures during the Trump administration have brought forward major proposals to lower federal Medicaid funding and change the structure of the program. The “One Big Beautiful Bill Act,” signed in 2025, is estimated to cut over $1 trillion in Medicaid funding from the federal government over 10 years. It introduces policies such as work requirements and greater cost-sharing, which are expected to reduce both coverage and funding for some people, with more costs shifted to states as federal support growth slows—even as tens of millions continue to rely on Medicaid.

Note: HCPCS codes are given for context within the service group. Rankings and totals discussed in this article use standardized category groupings, not individual billing codes.

Data cited in this article are from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original data set can be accessed here.