Berlin health care providers claimed $318,289 in Medicaid reimbursements for Pathology and Laboratory Procedures services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This amount was up by 0.3% from $317,345 billed for the same category in 2023.
Medicaid, a joint state and federal public health insurance program, covers populations including low-income individuals, families, seniors, children, and those with disabilities, making it among the nation’s largest health care expenditures. The program is funded through contributions from federal and state governments.
Since Medicaid is financed with taxpayer dollars, shifts in local billing reflect how public health funding is distributed within each community.
The “Pathology and Laboratory Procedures” classification covers specific Medicaid-billed services grouped by care type according to standardized HCPCS and CPT code ranges. The analysis assigns each billing code to one service category by applying consistent code prefixes and numbers, allowing related services to be tabulated together and preventing double counting or errors in ranking.
Even though overall Medicaid expenditures went up in several areas, Pathology and Laboratory Procedures was the third largest Medicaid spending category in Berlin during 2024.
Statewide, Pathology and Laboratory Procedures ranked ninth among Vermont Medicaid payment categories for the year.
Between 2019 and 2024, Medicaid payments connected to Pathology and Laboratory Procedures in Berlin grew by $273,525—or 611%. The pace of spending accelerated at several points, with sharp increases reported particularly in 2021 and 2022.
The distribution of these Medicaid payments spanned Berlin, but the vast majority were concentrated in particular ZIP codes. In 2024, ZIP code 05641 accounted for $314,787 and ZIP code 05602 for $3,502—together making up all Medicaid payments for Pathology and Laboratory Procedures in the city.
Within the Pathology and Laboratory Procedures service group, payments were further focused among a limited selection of specific billing codes.
Comparing changes, Medicaid spending on Pathology and Laboratory Procedures in Berlin grew 0.3% from 2023 to 2024, while all Medicaid categories combined in the city saw a 9.8% shift over the same period.
Centers for Medicare & Medicaid Services data show that combined federal and state Medicaid outlays withstood significant expansion, totaling roughly $871.7 billion in fiscal year 2023 and accounting for about 18% of the country’s health spending, up from $613.5 billion pre-pandemic in 2019.
This growth represents a surge of about 40% in just a few years, largely driven by expanded coverage and higher use of services surrounding the pandemic era.
Recent federal budget actions during the Trump administration included substantial proposals to curtail federal Medicaid spending and adjust its structure. For example, the “One Big Beautiful Bill Act,” signed into law in 2025, aims to reduce federal Medicaid disbursements by more than $1 trillion over the next 10 years and put new requirements in place, such as work mandates and higher cost-sharing for some enrollees. These measures could lower coverage and shift additional costs to states even as Medicaid serves tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $44,764 | -18.1% |
| 2021 | $413,068 | 822.8% |
| 2022 | $453,979 | 9.9% |
| 2023 | $317,344 | -30.1% |
| 2024 | $318,289 | 0.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Alcohol and Drug Abuse Treatment | $12,577,865 | 82.1% |
| 2 | Evaluation and Management | $2,114,734 | 13.8% |
| 3 | Pathology and Laboratory Procedures | $318,289 | 2.1% |
| 4 | National Codes Established for State Medicaid Agencies | $222,714 | 1.5% |
| 5 | Medicine Services and Procedures | $52,366 | 0.3% |
| 6 | Procedures / Professional Services | $27,100 | 0.2% |
| 7 | Radiology Procedures | $9,391 | 0.1% |
| 8 | Dental Services | $954 | <0.1% |
| 9 | Surgery | $501 | <0.1% |
| 10 | Drugs Administered Other than Oral Method | $414 | <0.1% |
| 11 | Administrative, Miscellaneous and Investigational | $125 | <0.1% |
| 12 | Temporary National Codes (Non-Medicare) | $51 | <0.1% |
| 13 | Medical And Surgical Supplies | $15 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 87428 | Sarscov & inf vir a&b ag ia | $190,469 | 61 |
| 87430 | Strep a ag ia | $56,466 | 81 |
| 87426 | Sarscov coronavirus ag ia | $40,604 | 25 |
| 87400 | Influenza a/b each ag ia | $19,914 | 25 |
| 87420 | Resp syncytial virus ag ia | $3,337 | 10 |
| 80051 | Electrolyte panel | $2,692 | 2 |
| 81025 | Urine pregnancy test | $2,136 | 12 |
| 81003 | Urinalysis auto w/o scope | $1,530 | 12 |
| 80053 | Comprehen metabolic panel | $619 | 2 |
| 86308 | Heterophile antibody screen | $296 | 5 |
| 87880 | Strep a assay w/optic | $163 | 4 |
| 82962 | Glucose blood test | $30 | 3 |
| 83036 | Hemoglobin glycosylated a1c | $19 | 1 |
| 85025 | Complete cbc w/auto diff wbc | $7 | 8 |
| 82040 | Assay of serum albumin | $0 | 2 |
| 82310 | Assay of calcium | $0 | 2 |
| 82728 | Assay of ferritin | $0 | 1 |
| 83540 | Assay of iron | $0 | 1 |
| 83550 | Iron binding test | $0 | 1 |
| 83735 | Assay of magnesium | $0 | 1 |
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.
