In 2024, Medicaid providers in Summersville billed a total of $57,737 for services labeled under the Procedures / Professional Services category, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total reflects a 5.6% rise from 2023, when $54,688 was billed for the same service type.
Medicaid, operated by the states and funded in partnership between federal and state governments, provides health coverage for people with low incomes, seniors, children, and individuals with disabilities, making it one of the largest components of the U.S. health system.
Since taxpayer funds support Medicaid payments, shifts in local billing rates demonstrate how public health care resources are distributed in the community.
The “Procedures / Professional Services” classification encompasses a range of Medicaid-billed services grouped by care type, using standardized HCPCS and CPT code clusters. In this analysis, each billing code was allocated to a single service category using uniform code prefixes and numeric bands, enabling the study of related services collectively, while preventing overlaps and supporting accurate rankings over time.
Although Medicaid spending increased in several service categories, Procedures / Professional Services held the eighth spot for total Medicaid payments in Summersville in 2024.
Statewide in West Virginia, Procedures / Professional Services also ranked eighth by total Medicaid payouts in 2024.
Between the five years leading into 2024, Medicaid payments for Procedures / Professional Services in Summersville grew by $23,322, or 28.8%. Certain years saw more rapid growth, including notable increases in 2023 and 2020.
While Medicaid spending in this category spanned the city, most payments were focused in a small number of ZIP codes. For 2024, ZIP code 26651 registered $57,736 in Medicaid payments for Procedures / Professional Services. The top ZIP code accounted for 100% of such Medicaid payments in Summersville for the year.
Payments were also concentrated among a small pool of individual billing codes within the Procedures / Professional Services category.
As a point of comparison, Procedures / Professional Services payments in Summersville grew by 5.6% from 2023 to 2024, while all Medicaid claim categories in the city saw an 11.9% change in the same timeframe.
According to the Centers for Medicare & Medicaid Services, total combined Medicaid spending at the federal and state levels reached approximately $871.7 billion in fiscal year 2023, representing about 18% of the nation’s total health spending. This is a sharp rise from around $613.5 billion in 2019, before the COVID-19 pandemic.
This increase amounts to roughly 40% growth within a short period, largely attributed to increased enrollment and heightened service demand during and after the pandemic.
Recent federal budget measures enacted during the Trump administration included major proposals to trim federal Medicaid funding and adjust the program. For instance, the “One Big Beautiful Bill Act,” passed in 2025, is estimated to cut more than $1 trillion in federal Medicaid funding over 10 years. It also introduces work requirements and higher cost-sharing, potentially leading to less coverage and funding for some enrollees. These policy changes are anticipated to shift additional costs to states and restrict growth in federal Medicaid contributions, even as the program continues serving tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $81,059 | 9.1% |
| 2021 | $53,139 | -34.4% |
| 2022 | $39,790 | -25.1% |
| 2023 | $54,688 | 37.4% |
| 2024 | $57,736 | 5.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $2,907,398 | 45.3% |
| 2 | Evaluation and Management | $1,890,612 | 29.4% |
| 3 | Medicine Services and Procedures | $464,774 | 7.2% |
| 4 | Pathology and Laboratory Procedures | $463,620 | 7.2% |
| 5 | Radiology Procedures | $224,266 | 3.5% |
| 6 | Medical And Surgical Supplies | $166,296 | 2.6% |
| 7 | Durable Medical Equipment | $147,584 | 2.3% |
| 8 | Procedures / Professional Services | $57,736 | 0.9% |
| 9 | Dental Services | $39,947 | 0.6% |
| 10 | Surgery | $33,546 | 0.5% |
| 11 | Vision Services | $19,312 | 0.3% |
| 12 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $5,131 | 0.1% |
| 13 | Drugs Administered Other than Oral Method | $2,691 | <0.1% |
| 14 | Temporary Codes | $960 | <0.1% |
| 15 | Ambulance and Other Transport Services and Supplies | $291 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| G9002 | Mccd,maintenance rate | $45,492 | 10 |
| G0378 | Hospital observation per hr | $12,132 | 4 |
| G0463 | Hospital outpt clinic visit | $97 | 1 |
| G0439 | Ppps, subseq visit | $14 | 4 |
Note: HCPCS codes are included to illustrate the makeup of the category. The totals and rankings referenced in this article use standardized service groupings rather than individual billing codes.
All information in this report is sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The underlying data is available here.
