Medicaid spending in Pennsylvania

1. Agencies — home care, case management, community support
   34¢
2. Clinics and outpatient centers
   18¢
3. Physicians
   11¢
4. Medical equipment and supplies
   9¢
5. Counselors, therapists and social workers
   6¢
6. Hospitals (outpatient claims only)
   5¢
7. Residential treatment
   3¢
8. Laboratories
   2¢

Cents of every dollar billed by Pennsylvania-based providers, grouped by each provider's primary NPPES type. Compare: nationally, agencies take 33¢ and physicians 11¢.

1. W1793State-specific procedure code
   $2.2B
2. T1015A visit at a community health center or clinic (one all-in rate)
   $2.0B
3. H2036Alcohol and/or other drug treatment program, per diem
   $1.0B
4. S9124Nursing care, in the home; by licensed practical nurse, per hour
   $847M
5. 90834Psychotherapy session, about 45 minutes
   $702M
6. W7210State-specific procedure code
   $687M
7. 99284Emergency room visit (serious)
   $658M
8. 97153Applied behavior analysis (autism therapy), per 15 minutes
   $592M
9. T1017Case management, billed per 15 minutes
   $591M
10. 99214Doctor's office visit, returning patient (more involved)
    $558M

Statistical outliers on claims per beneficiary, single-code billing, and OIG exclusion. Not evidence of fraud — how these work.