Englewood sees $30 in Medicaid Surgery claims for 2024, marking 900% increase

In 2024, Medicaid providers in Englewood billed $30 for services within the Surgery category, U.S. Department of Health and Human Services Medicaid Provider Spending data show. This represents a 900% rise from 2023, when claims for the same category totaled $3.

Medicaid, a public health insurance initiative administered by states and funded jointly by the federal and state governments, provides coverage to low-income individuals, families, seniors, children, and those with disabilities, making it one of America’s largest health care programs.

Because Medicaid draws on taxpayer funding, shifts in local service billing reflect how public health care resources are distributed in a given community.

The “Surgery” category consists of Medicaid-billed services identified by the type of care, based on standard groupings of HCPCS and CPT codes. Each billing code was assigned to one service category using consistent code prefixes and ranges to analyze related services together, prevent double counting, and maintain precise rankings over years.

Medicaid spending increased across several service categories, with Surgery ranked fourth by total Medicaid claims in Englewood for 2024.

Statewide in Tennessee, Surgery placed 10th among Medicaid payment categories in 2024.

From five years prior to 2024, Medicaid payments connected to Surgery in Englewood grew by $170, or 85%. Growth in spending was especially significant in selected years, with notable increases occurring in 2023 and 2022.

Though Surgery claims were submitted citywide, payments were highly concentrated in certain ZIP codes. For 2024, ZIP code 37329 received $30, representing all Medicaid payments in the Surgery category for Englewood that year. The top single ZIP code accounted for 100% of such payments in the city.

Within the Surgery category, most Medicaid payments targeted only a few billing codes.

For context, Surgery-related Medicaid payments in Englewood climbed 900% from 2023 to 2024, while all Medicaid claim categories in the city increased by 96.2% during the same period.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid outlays reached about $871.7 billion in fiscal year 2023. This made up around 18% of all U.S. health spending, a significant jump from about $613.5 billion in 2019 before the COVID-19 pandemic.

This increase equates to roughly 40% growth, propelled mainly by expanded enrollment and higher service use during and after the pandemic.

Recently enacted federal budget measures under the Trump administration introduced notable reductions to federal Medicaid support and new program structures. For instance, the “One Big Beautiful Bill Act,” became law in 2025 and is expected to lower federal Medicaid outlays by more than $1 trillion over the next decade. The law also imposes new work conditions and increases cost-sharing, potentially reducing funding and coverage for certain beneficiaries. These changes are likely to shift more of the burden to states and limit the expansion of federal Medicaid aid, even as the program continues to support millions nationwide.

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.