Pennsylvania
#13 in Medicaid spending (2.55% of national total)
Total Spending
$27.88B
Total Claims
356.4M
Providers
30,709
Avg Cost/Claim
$78
Data Coverage Note: Pennsylvania has 95% of Medicaid enrollees in managed care. This data covers only fee-for-service (FFS) claims (est. 5% of enrollees). Actual total Medicaid spending in Pennsylvania is significantly higher than shown.
Enrollment (Latest)
3.1M
Managed Care
95%
ACA Expansion
Yes (2015)
FFS $/Enrollee
$2,147
Yearly Spending Trend
Year-over-Year Growth
Top Providers
| Provider | Total Paid▼ |
|---|---|
ZOLL SERVICES LLC Durable Medical Equipment & Medical Supplies | $504.0M |
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF EDUCATION Local Education Agency (LEA) | $326.0M |
EXCEL COPMANION CARE INC Home Health | $308.4M |
CHILDRENS HOSPITAL OF PHILADELPHIA Clinic/Center | $286.9M |
PROCARE PHARMACY DIRECT, LLC. Pharmacy | $227.3M |
NORTHEAST PENNSYLVANIA CENTER FOR INDEPENDENT LIVING Contractor | $227.2M |
TOBII DYNAVOX LLC Durable Medical Equipment & Medical Supplies | $182.1M |
WHITE DEER RUN, LLC Rehabilitation Unit | $145.8M |
PATRIOT HOME CARE, INC Home Health | $135.8M |
QUEST DIAGNOSTICS OF PENNSYLVANIA, INC. Clinical Medical Laboratory | $132.4M |
ACCREDO HEALTH GROUP INC Pharmacy | $130.9M |
SERVICE ACCESS AND MANAGEMENT INC Community/Behavioral Health | $128.9M |
PYRAMID HEALTH CARE INC. Clinic/Center | $128.8M |
ACT HOME HEALTH SERVICES, INC Home Health | $126.0M |
UPMC PRESBYTERIAN SHADYSIDE Clinic/Center | $125.5M |
WESLEY FAMILY SERVICES Clinic/Center | $123.4M |
TEMPLE UNIVERSITY HOSPITAL, INC General Acute Care Hospital | $116.5M |
CITY OF PHILADELPHIA Ambulance | $108.1M |
THE WRIGHT CENTER MEDICAL GROUP Internal Medicine | $106.1M |
EPIC HEALTH SERVICES (PA), LLC Home Health | $104.4M |
20 rows
Top Procedures
| Code | Description | Total Paid▼ |
|---|---|---|
| W1793 | (no description) | $2.19B |
| T1015 | Clinic service | $2.04B |
| H2036 | A/d tx program, per diem | $1.02B |
| S9124 | Nursing care, in the home; b | $846.8M |
| 90834 | Psytx w pt 45 minutes | $702.1M |
| W7210 | (no description) | $686.9M |
| 99284 | Emergency dept visit mod mdm | $657.6M |
| 97153 | Adaptive behavior tx by tech | $592.5M |
| T1017 | Targeted case management | $591.1M |
| 99214 | Office o/p est mod 30 min | $558.0M |
| T1003 | Lpn/lvn services up to 15min | $512.8M |
| K0606 | (no description) | $504.0M |
| 99213 | Office o/p est low 20 min | $498.0M |
| H0004 | Alcohol and/or drug services | $497.2M |
| 99283 | Emergency dept visit low mdm | $431.0M |
| H0018 | Alcohol and/or drug services | $426.7M |
| 99285 | Emergency dept visit hi mdm | $349.1M |
| T1019 | Personal care ser per 15 min | $346.3M |
| H2021 | Com wrap-around sv, 15 min | $319.8M |
| S9123 | Nursing care in home rn | $295.2M |
20 rows
Provider Classification Breakdown
| Classification | Total Paid▼ | Providers |
|---|---|---|
| Clinic/Center | $4.92B | 1,535 |
| Home Health | $4.15B | 404 |
| Community/Behavioral Health | $2.43B | 517 |
| Durable Medical Equipment & Medical Supplies | $1.74B | 400 |
| Case Management | $1.50B | 206 |
| General Acute Care Hospital | $1.18B | 172 |
| Counselor | $687.3M | 820 |
| Ambulance | $626.7M | 459 |
| Substance Abuse Rehabilitation Facility | $623.9M | 69 |
| Pharmacy | $622.4M | 114 |
| Clinical Medical Laboratory | $613.2M | 95 |
| Dentist | $582.7M | 2,086 |
| Pediatrics | $536.5M | 1,520 |
| Family Medicine | $526.0M | 2,919 |
| In Home Supportive Care | $518.9M | 115 |
| Psychologist | $442.8M | 318 |
| Internal Medicine | $437.9M | 3,532 |
| Emergency Medicine | $359.5M | 1,292 |
| Local Education Agency (LEA) | $353.7M | 10 |
| Behavior Analyst | $331.6M | 41 |