Fairmont Medicaid providers submit $689,040 in claims for procedures and professional services for 2024

In 2024, Fairmont Medicaid providers submitted $689,040 in claims for services in the Procedures / Professional Services category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 3.7% increase over 2023, when billing for this service type was $664,173.

Medicaid is a state-run health insurance program jointly financed by federal and state governments, providing coverage for low-income people, seniors, children, and people with disabilities. This makes it one of the largest programs in the U.S. health care system. For more details, see here.

Shifts in local Medicaid billing levels reflect how community tax dollars are allocated for public health care through this program.

The “Procedures / Professional Services” group covers specific Medicaid-billed services as defined by standardized HCPCS and CPT code sets. In this analysis, each billing code falls under a single service category, using unified code prefixes and number ranges, which enables the analysis of related services as a group while avoiding any double counting and maintaining consistent rankings.

While overall Medicaid spending rose in several areas, Procedures / Professional Services finished 6th among payment categories in Fairmont for 2024 by total Medicaid dollar volume.

Across West Virginia statewide, Procedures / Professional Services was the 8th largest category by total Medicaid payments in 2024.

Over five years through 2024, Medicaid payments in this service group in Fairmont increased by $298,678, or 76.5%. Periods of strong growth included significant annual increases in both 2023 and 2022.

Payments for Procedures / Professional Services were made throughout Fairmont but were heavily concentrated in a small number of ZIP codes. The ZIP code 26554 saw total Medicaid payments of $689,040 for this category in 2024. Altogether, the leading ZIP code—26554—accounted for 100% of Medicaid Procedures / Professional Services spending in the city that year.

Medicaid claims for Procedures / Professional Services in Fairmont were also clustered among a small group of specific billing codes.

Comparing the change in Fairmont’s Medicaid Procedures / Professional Services payments between 2024 and 2023 reveals a 3.7% increase, while total Medicaid claims in all categories citywide rose by 20.1% during that same time period.

According to the Centers for Medicare & Medicaid Services, Medicaid spending from both federal and state budgets came to approximately $871.7 billion nationwide in fiscal year 2023. That equaled about 18% of the country’s health care spending, which was up from about $613.5 billion in 2019, before the COVID-19 pandemic.

This surge amounts to an increase of roughly 40% in just a few years, mainly due to more people enrolling and greater use of services during and following the COVID-19 pandemic.

Recent federal budget actions during the Trump administration brought sweeping efforts to reduce federal Medicaid contributions and change the structure of the program. The “One Big Beautiful Bill Act,” enacted in 2025, is projected to trim more than $1 trillion in federal Medicaid funding over the coming decade and puts in place rules such as work requirements and higher cost-sharing for some enrollees. These measures are expected to raise states’ share of Medicaid costs and could slow the growth of federal support, even as the program remains vital to millions.

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.