Medicare provider payments and utilization data for Pennsylvania (PA)
Pennsylvania received $34.5B in total Medicare provider payments across 10 years of data.
The top specialty by spending is Ophthalmology, accounting for $355.7M in payments across 799 providers.
In 2023, 58.1K providers were actively billing Medicare in Pennsylvania.
AI-generated analysis based on Medicare payment data.
Providers in this state flagged by the ML v2 fraud detection model
| Year | Payments | Services | Providers | YoY Change |
|---|---|---|---|---|
| 2014 | $3.1B | 83.3M | 47.7K | — |
| 2015 | $3.2B | 86.0M | 49.2K | +2.4% |
| 2016 | $3.3B | 87.7M | 50.8K | +2.8% |
| 2017 | $3.4B | 87.6M | 52.3K | +1.7% |
| 2018 | $3.5B | 96.4M | 53.8K | +4.8% |
| 2019 | $3.6B | 119.9M | 55.3K | +3.0% |
| 2020 | $3.3B | 102.2M | 54.7K | -10.0% |
| 2021 | $3.7B | 107.4M | 56.2K | +13.9% |
| 2022 | $3.6B | 101.3M | 57.3K | -4.1% |
| 2023 | $3.8B | 110.7M | 58.1K | +5.3% |
| Code | Description | Payments | Services | Providers |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | $337.7M | 4.2M | 23.2K |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | $171.4M | 3.0M | 22.4K |
| J0178 | Injection, aflibercept, 1 mg | $121.1M | 176.0K | 140 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $103.8M | 1.7M | 10.9K |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $79.9M | 863.6K | 6.6K |
| 99285 | Emergency department visit with high level of medical decision making | $65.5M | 476.5K | 3.2K |
| 66984 | Removal of cataract with insertion of prosthetic lens | $65.0M | 121.6K | 665 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | $61.6M | 524.4K | 7.2K |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $54.6M | 413.3K | 7.0K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | $54.0M | 137.7K | 457 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | $51.3M | 457.9K | 10.3K |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | $50.1M | 461.6K | 5.2K |
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $49.7M | 2.8M | 3.3K |
| J0897 | Injection, denosumab, 1 mg | $47.1M | 2.6M | 526 |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | $46.7M | 141.1K | 538 |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $45.4M | 601.1K | 1.7K |
| 99291 | Critical care, first 30-74 minutes | $44.5M | 264.0K | 3.8K |
| 87798 | Detection test by nucleic acid for organism, amplified probe technique | $40.8M | 1.2M | 37 |
| 97530 | Therapy procedure using functional activities | $39.2M | 1.5M | 2.5K |
| J2777 | Injection, faricimab-svoa, 0.1 mg | $34.6M | 1.2M | 96 |
| Specialty | Payments | Providers | Avg per Provider |
|---|---|---|---|
| Ophthalmology | $355.7M | 799 | $445.2K |
| Clinical Laboratory | $250.0M | 70 | $3.6M |
| Internal Medicine | $249.4M | 4.2K | $59.1K |
| Family Practice | $212.9M | 4.1K | $52.3K |
| Ambulance Service Provider | $159.9M | 599 | $266.9K |
| Ambulatory Surgical Center | $159.2M | 219 | $727.0K |
| Nurse Practitioner | $155.7M | 6.8K | $22.8K |
| Physical Therapist in Private Practice | $146.2M | 3.0K | $49.5K |
| Cardiology | $135.0M | 1.0K | $129.2K |
| Diagnostic Radiology | $131.4M | 1.5K | $84.9K |
| Rheumatology | $110.4M | 256 | $431.2K |
| Physician Assistant | $105.4M | 6.0K | $17.7K |
| Emergency Medicine | $102.2M | 2.6K | $39.4K |
| Dermatology | $96.4M | 518 | $186.1K |
| Orthopedic Surgery | $95.1M | 937 | $101.5K |
| Mass Immunizer Roster Biller | $85.8M | 1.6K | $54.2K |
| Hematology-Oncology | $80.1M | 409 | $195.9K |
| Podiatry | $78.2M | 951 | $82.3K |
| Pharmacy | $59.4M | 127 | $468.0K |
| Hospitalist | $58.9M | 1.1K | $52.6K |
| Physical Medicine and Rehabilitation | $46.8M | 484 | $96.8K |
| Nephrology | $45.1M | 446 | $101.1K |
| Gastroenterology | $44.0M | 752 | $58.5K |
| Optometry | $42.1M | 1.4K | $29.3K |
| Pathology | $41.8M | 589 | $71.0K |
Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.