In South Charleston, Medicaid providers reported $1,091,670 in billings for services included in the Procedures / Professional Services category for 2024, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount reflects a 0.4% rise from 2023, when claims for the same category totaled $1,087,783.
Medicaid, a public health insurance plan operated by the states and funded by both federal and state governments, serves low-income residents, seniors, children, and those with disabilities, making it one of the largest pieces of the national health care system.
Changes in local Medicaid billing demonstrate how public health care funds, mainly sourced from taxpayers, are distributed within communities.
The Procedures / Professional Services classification includes a set of Medicaid-billable services, categorized by specific types of care through HCPCS and CPT coding groups. In compiling this analysis, service codes were placed in a single category using consistent code prefixes and number ranges to ensure comparable groupings while preventing duplicate counts and maintaining accuracy in category rankings over time.
Medicaid spending increased across various groups, but Procedures / Professional Services was the fifth-highest category in South Charleston by overall Medicaid payments for 2024.
For the state of West Virginia, this Procedures / Professional Services group was ranked eighth overall in total Medicaid payments during 2024.
Looking at the five years leading up to 2024, Medicaid payments for Procedures / Professional Services in South Charleston climbed by $186,846, or 20.6%. The rate of above-average year-to-year growth was particularly notable in 2020 and 2023.
Spending on Procedures / Professional Services was distributed throughout South Charleston, although it was mainly concentrated in a small number of ZIP codes. In 2024, ZIP code 25303 accounted for $964,806, and 25309 made up $126,862. Combined, these top 2 ZIP codes made up 100% of all Medicaid payments for Procedures / Professional Services in South Charleston for the year.
Within the broader Procedures / Professional Services grouping, a relatively small portion of individual billing codes accounted for the majority of Medicaid payments.
Medicaid payments for this specific category in South Charleston increased 0.4% from 2023 to 2024, while all Medicaid claim categories citywide saw a 13.7% change in the same period.
Data from the Centers for Medicare & Medicaid Services show that combined federal and state Medicaid spending hit about $871.7 billion in fiscal year 2023. That amount made up nearly 18% of all national health expenditures—an increase from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This upward trend indicates nearly 40% growth within just a few years, largely due to expanded program enrollment and greater usage during and following the pandemic.
Recent legislation under the Trump administration has put forth broad changes to federal Medicaid funding and program structure. The “One Big Beautiful Bill Act,” passed in 2025, is expected to trim federal Medicaid spending by over $1 trillion over the next decade. The law also brings in policies such as work requirements and increased cost-sharing, changes that could limit coverage for certain beneficiaries and push more costs onto state budgets, even as the program continues to serve tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $904,824 | 29.6% |
| 2021 | $817,059 | -9.7% |
| 2022 | $842,007 | 3.1% |
| 2023 | $1,087,783 | 29.2% |
| 2024 | $1,091,669 | 0.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $9,712,359 | 38.8% |
| 2 | Temporary National Codes (Non-Medicare) | $6,364,435 | 25.4% |
| 3 | Durable Medical Equipment | $2,351,576 | 9.4% |
| 4 | Pathology and Laboratory Procedures | $1,449,639 | 5.8% |
| 5 | Procedures / Professional Services | $1,091,669 | 4.4% |
| 6 | National Codes Established for State Medicaid Agencies | $1,066,109 | 4.3% |
| 7 | Radiology Procedures | $806,678 | 3.2% |
| 8 | Alcohol and Drug Abuse Treatment | $740,395 | 3% |
| 9 | Medicine Services and Procedures | $606,230 | 2.4% |
| 10 | Surgery | $308,442 | 1.2% |
| 11 | Medical And Surgical Supplies | $240,206 | 1% |
| 12 | Ambulance and Other Transport Services and Supplies | $113,348 | 0.5% |
| 13 | Vision Services | $95,090 | 0.4% |
| 14 | Drugs Administered Other than Oral Method | $22,513 | 0.1% |
| 15 | Orthotic Procedures and services | $19,071 | 0.1% |
| 16 | Administrative, Miscellaneous and Investigational | $16,265 | 0.1% |
| 17 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $11,274 | <0.1% |
| 18 | Temporary Codes | $166 | <0.1% |
| 19 | Anesthesia | $8 | <0.1% |
| 20 | Outpatient PPS | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| G9002 | Mccd,maintenance rate | $964,794 | 21 |
| G0463 | Hospital outpt clinic visit | $68,527 | 36 |
| G0480 | Drug test def 1-7 classes | $31,693 | 20 |
| G0378 | Hospital observation per hr | $19,517 | 11 |
| G0481 | Drug test def 8-14 classes | $5,437 | 3 |
| G2211 | Complex e/m visit add on | $1,129 | 20 |
| G0279 | Tomosynthesis, mammo | $569 | 2 |
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.
