Stoughton sees $113,144 in Medicaid payments for procedures, professional services in 2024

Data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows Medicaid providers in Stoughton billed $113,144 in 2024 for Procedures / Professional Services, up from $63,996 in 2023. This reflects a 76.8% rise in claims for these services compared to the prior year.

Medicaid, a major U.S. public health insurance program, is jointly funded by federal and state governments and run by the states. It provides coverage for low-income individuals, seniors, children, and those with disabilities.

Because Medicaid is paid for by taxpayers, changes in local billing levels help show how public health care resources are distributed within a community.

The Procedures / Professional Services category groups Medicaid-billed services according to the type of care given, using standardized HCPCS and CPT codes. For this report, each billing code was assigned to one service category using code prefixes and numeric ranges. This method enables related services to be analyzed together, avoids double-counting, and maintains accurate year-to-year rankings.

Procedures / Professional Services held the No. 4 spot by total Medicaid payments among service categories in Stoughton in 2024, while several other categories also experienced increased spending.

Statewide in Wisconsin, Procedures / Professional Services ranked 11th in total Medicaid payments for 2024.

In the five years preceding 2024, Medicaid payments related to Procedures / Professional Services in Stoughton rose by $102,836, a 997.6% increase. Most of the growth occurred during certain periods, with significant annual increases in both 2022 and 2023.

Spending for this care type occurred throughout Stoughton, but a small number of ZIP codes saw the most Medicaid payments. In 2024, ZIP code 53589 received $113,143 for Procedures / Professional Services, representing 100% of these payments in Stoughton for the year.

Payments within this category were also focused on a select group of individual billing codes.

While Stoughton’s Medicaid payments for Procedures / Professional Services climbed 76.8% from 2023 to 2024, the city’s overall Medicaid spending across all categories increased 30.3% over the same period.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending combined reached about $871.7 billion in fiscal year 2023. That figure makes up approximately 18% of national health expenditures—a rise from roughly $613.5 billion in 2019, before the COVID-19 pandemic.

The total has grown around 40% in just a few years, mainly due to more people enrolling and greater use of medical services during and after the pandemic.

Recent federal budget measures under the Trump administration have brought significant Medicaid policy changes, aiming to reduce federal funding and restructure the program. For example, the “One Big Beautiful Bill Act,” signed in 2025, is expected to lower federal Medicaid spending by more than $1 trillion over the next 10 years. This legislation adds work requirements and more cost-sharing, which could restrict access and funding for certain beneficiaries. As a result, costs are likely to shift to states, limiting federal Medicaid growth while the program continues serving tens of millions of Americans.

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.