Medicaid surgery payments in Edgerton surge to $343,988 in 2024

In 2024, Medicaid providers in Edgerton billed $343,988 for services categorized under Surgery, according to information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 714.6% rise compared to 2023, when $42,228 in claims were submitted for the same service category.

Medicaid operates as a public health insurance program administered by the states and funded jointly by federal and state governments. It serves low-income individuals and families, seniors, children, and people with disabilities, making it a cornerstone of the U.S. health care system.

Because Medicaid is funded by taxpayers, shifts in local billing levels reveal how public health funds are distributed in each community.

The “Surgery” category comprises a collection of Medicaid-billed services determined by the nature of the care, using standard HCPCS and CPT code groupings. Codes for this review were assigned to only one service category, based on consistent code prefixes and numeric series, to group related services for analysis and avoid duplicate counting while maintaining accuracy in ranking over time.

While Medicaid expenditures rose in several service categories, Surgery placed second in Edgerton by total Medicaid payments in 2024.

Statewide, the Surgery category ranked ninth in total Medicaid payments in Wisconsin during 2024.

Analyzing the five years up to 2024, Medicaid spending for the Surgery category in Edgerton rose by $229,492, marking an increase of 200.4%. The pace of this growth shifted periodically, with significant year-over-year increases noted in 2020 and 2023.

Although Surgery category payments were made for care delivered across Edgerton, most funding was concentrated within a few ZIP codes. In 2024, the highest payments corresponded to ZIP code 53534, totaling $343,988. That year, the top ZIP code accounted for 100% of the city’s Surgery category Medicaid payments.

Payments in the Surgery category were also focused among a small group of specific billing codes.

In comparison, the rise in Medicaid payments tied to Surgery in Edgerton reached 714.6% from 2023 to 2024, whereas all Medicaid claim categories in the city increased by 10.3% during that same timeframe.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures were about $871.7 billion in fiscal year 2023, roughly 18% of total health spending nationwide. That amount rose from about $613.5 billion in 2019, prior to the COVID-19 pandemic.

This reflects a growth rate of around 40% over several years, attributed primarily to increased enrollment and higher service utilization during and after the pandemic period.

Recent federal budget acts during the Trump administration have contained significant proposals for reducing federal Medicaid funding and revising the program. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to cut federal Medicaid spending by over $1 trillion over the coming decade. The law also introduces measures such as work requirements and expanded cost-sharing that could affect coverage and financial support for certain beneficiaries. These adjustments are anticipated to push more expenses to the states and constrain future federal Medicaid growth, even as the program serves tens of millions of Americans.

Note: HCPCS codes are presented for contextual purposes within each category. Totals and rankings featured in this article are based on standardized groupings of services, not individual billing codes.

Details in this article are sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original data is available here.