Medicaid providers in South Boston billed $3,037,090 for services classified under the National Codes Established for State Medicaid Agencies category in 2024, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 4.4% rise from 2023, when $2,908,428 in claims were submitted for these services.
Medicaid is a publicly run health insurance program operated by the states and supported through joint funding from federal and state governments. The program covers low-income individuals, seniors, children, and those with disabilities, making it one of the largest segments of the U.S. health care sector.
Since Medicaid is funded by taxpayers, local billing trends indicate how public health dollars are allocated within communities.
The “National Codes Established for State Medicaid Agencies” category represents Medicaid-billed services grouped by care type based on standardized HCPCS and CPT code sets. For this report, each billing code was assigned to a service category using consistent code prefixes and ranges. This methodology groups similar services while preventing double counting and enables accurate yearly comparisons.
While various service categories experienced increased Medicaid spending, National Codes Established for State Medicaid Agencies stood as the second-largest category in South Boston by total Medicaid payments in 2024.
Statewide in Virginia, the National Codes Established for State Medicaid Agencies category was the leading category by the amount paid in 2024.
From the five years leading up to 2024, South Boston saw Medicaid payments in this category rise by $1,245,953, or 69.6%. Some periods showed faster growth, with significant jumps in 2022 and 2021.
The National Codes Established for State Medicaid Agencies category’s service payments were distributed throughout the city but were most prominent in certain ZIP codes. In 2024, ZIP code 24592 accounted for $3,037,089 of the category’s payments. In total, the highest-paying ZIP code comprised 100% of all Medicaid payments for this category in South Boston in 2024.
Within the category, a small number of individual billing codes drew most of the Medicaid payments.
Comparing overall rates, payments tied to the National Codes Established for State Medicaid Agencies category in South Boston went up 4.4% between 2024 and 2023, while total claims across all Medicaid categories in the city increased by 37.3% over the same period.
Data from the Centers for Medicare & Medicaid Services shows that combined federal and state Medicaid expenditure reached approximately $871.7 billion in fiscal 2023. This accounted for about 18% of national health spending, a significant rise from nearly $613.5 billion in 2019, before the COVID-19 pandemic.
This growth marks an increase of about 40% in only a few years, mainly driven by greater enrollment and utilization during and following the pandemic period.
Legislation enacted under the Trump administration has included major proposals to lower federal Medicaid funding and to change program structure. The “One Big Beautiful Bill Act,” signed into law in 2025, is projected to reduce federal Medicaid payments by over $1 trillion during the next decade and introduces new policies such as work mandates and higher cost-sharing. These changes could decrease coverage and funding for some users, shift more responsibility to states, and limit growth in federal Medicaid contributions while the program continues to support millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,791,136 | 5.1% |
| 2021 | $2,098,411 | 17.2% |
| 2022 | $2,542,008 | 21.1% |
| 2023 | $2,908,427 | 14.4% |
| 2024 | $3,037,089 | 4.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $3,651,167 | 32.9% |
| 2 | National Codes Established for State Medicaid Agencies | $3,037,089 | 27.3% |
| 3 | Medicine Services and Procedures | $1,869,257 | 16.8% |
| 4 | Temporary National Codes (Non-Medicare) | $852,187 | 7.7% |
| 5 | Radiology Procedures | $704,735 | 6.3% |
| 6 | Surgery | $351,529 | 3.2% |
| 7 | Pathology and Laboratory Procedures | $210,739 | 1.9% |
| 8 | Procedures / Professional Services | $207,437 | 1.9% |
| 9 | Ambulance and Other Transport Services and Supplies | $111,772 | 1% |
| 10 | Medical And Surgical Supplies | $56,358 | 0.5% |
| 11 | Durable Medical Equipment | $46,289 | 0.4% |
| 12 | Drugs Administered Other than Oral Method | $5,470 | <0.1% |
| 13 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $1,550 | <0.1% |
| 14 | Temporary Codes | $111 | <0.1% |
| 15 | Administrative, Miscellaneous and Investigational | $16 | <0.1% |
| 16 | Dental Services | $0 | <0.1% |
| 16 | Outpatient PPS | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $2,288,496 | 25 |
| T2003 | N-et; encounter/trip | $399,855 | 16 |
| T1005 | Respite care service 15 min | $348,737 | 24 |
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.
