Providers in Bronx billed Medicaid a total of $728,848,516 for services in the National Codes Established for State Medicaid Agencies category during 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This amount represented a 5.7% increase over 2023, when claims in this category totaled $689,628,952.
Medicaid, funded together by federal and state governments and operated by the states, covers low-income individuals, seniors, children and people with disabilities, and is a key component of the U.S. health care system.
Since Medicaid dollars originate from taxpayers, fluctuations in billing reflect how community health care funding is distributed.
The National Codes Established for State Medicaid Agencies category groups Medicaid-billed services by care type, utilizing standardized HCPCS and CPT code groupings. For this report, each billing code was assigned to a single service grouping, using uniform code prefixes and ranges to keep related services together, prevent duplicate counting and maintain accurate rankings over time.
In 2024, this service category had the highest aggregate Medicaid payments in Bronx among all categories.
Statewide in New York, payments for National Codes Established for State Medicaid Agencies also led all categories in 2024.
During the five years ending in 2024, Medicaid expenditures tied to this category in Bronx increased by $207,848,108, or 39.9%. Growth in spending accelerated in some years, particularly noted in 2020 and 2023.
Medicaid spending within this service group was distributed throughout Bronx, but a few ZIP codes were responsible for most payments. In 2024, ZIP codes 10462 ($312,542,032), 10458 ($132,321,096), and 10465 ($65,184,393) together accounted for 70% of this category’s Medicaid payments in the borough.
Within the National Codes Established for State Medicaid Agencies group, a small set of billing codes represented a large share of payments.
Medicaid payments tied to this category in Bronx grew 5.7% from 2023 to 2024, compared with a 12.8% increase across all Medicaid claim categories locally during that period.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023, making up around 18% of total U.S. health expenditures. This is up from approximately $613.5 billion in 2019, before the COVID-19 pandemic.
This change represents an increase of about 40% over several years, mainly due to more enrollees and higher care use during and just after the pandemic.
Recent federal budget measures enacted during the Trump administration introduced significant plans to reduce federal Medicaid spending and restructure the program. The “One Big Beautiful Bill Act,” signed in 2025, is expected to cut over $1 trillion in federal Medicaid spending in the coming decade and sets new policies such as work requirements and increased cost-sharing. These changes may shift more financial responsibility to states and could curb the growth of federal Medicaid funding, while the program remains a resource for tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $521,000,408 | 26% |
| 2021 | $526,921,950 | 1.1% |
| 2022 | $576,084,714 | 9.3% |
| 2023 | $689,628,952 | 19.7% |
| 2024 | $728,848,515 | 5.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $728,848,515 | 51.2% |
| 2 | Evaluation and Management | $255,119,304 | 17.9% |
| 3 | Medicine Services and Procedures | $140,943,005 | 9.9% |
| 4 | Alcohol and Drug Abuse Treatment | $57,980,399 | 4.1% |
| 5 | Temporary National Codes (Non-Medicare) | $38,936,629 | 2.7% |
| 6 | Pathology and Laboratory Procedures | $31,931,234 | 2.2% |
| 7 | Surgery | $31,253,598 | 2.2% |
| 8 | Ambulance and Other Transport Services and Supplies | $29,396,734 | 2.1% |
| 9 | Radiology Procedures | $28,295,843 | 2% |
| 10 | Procedures / Professional Services | $23,237,807 | 1.6% |
| 11 | Durable Medical Equipment | $13,492,078 | 0.9% |
| 12 | Dental Services | $12,083,256 | 0.8% |
| 13 | Medical And Surgical Supplies | $9,242,269 | 0.6% |
| 14 | Chemotherapy Drugs | $8,887,485 | 0.6% |
| 15 | Drugs Administered Other than Oral Method | $6,051,165 | 0.4% |
| 16 | Vision Services | $1,847,603 | 0.1% |
| 17 | Anesthesia | $1,680,426 | 0.1% |
| 18 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $1,192,965 | 0.1% |
| 19 | Temporary Codes | $1,191,140 | 0.1% |
| 20 | Outpatient PPS | $1,066,552 | 0.1% |
| 21 | Pathology and Laboratory Services | $476,772 | <0.1% |
| 22 | Enteral and Parenteral Therapy | $348,379 | <0.1% |
| 23 | Administrative, Miscellaneous and Investigational | $292,861 | <0.1% |
| 24 | Orthotic Procedures and services | $279,118 | <0.1% |
| 25 | Hearing Services | $259,038 | <0.1% |
| 26 | Diagnostic Radiology Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $687,063,472 | 408 |
| T1020 | Personal care ser per diem | $8,576,749 | 52 |
| T1003 | Lpn/lvn services up to 15min | $8,026,811 | 19 |
| T1022 | Contracted services per day | $4,052,065 | 62 |
| T1002 | Rn services up to 15 minutes | $3,132,474 | 9 |
| T4523 | Adult size brief/diaper lg | $2,808,986 | 95 |
| T2024 | Serv asmnt/care plan waiver | $2,063,000 | 19 |
| T1017 | Targeted case management | $1,937,951 | 75 |
| T4522 | Adult size brief/diaper med | $1,732,626 | 94 |
| T4524 | Adult size brief/diaper xl | $1,607,541 | 101 |
| T4535 | Disposable liner/shield/pad | $1,555,785 | 60 |
| T2003 | N-et; encounter/trip | $1,436,873 | 101 |
| T4533 | Youth size brief/diaper | $967,207 | 37 |
| T1030 | Rn home care per diem | $781,232 | 43 |
| T4543 | Adult disp brief/diap abv xl | $681,072 | 20 |
| T4537 | Reusable underpad bed size | $626,137 | 71 |
| T4521 | Adult size brief/diaper sm | $419,374 | 32 |
| T1013 | Sign lang/oral interpreter | $362,060 | 310 |
| T1016 | Case management | $186,200 | 27 |
| T1015 | Clinic service | $163,838 | 46 |
Note: HCPCS codes are provided for context within the category. Category totals and rankings in this report rely on standardized service groupings, not individual billing codes.
The information for this article was obtained from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Access the source data here.
