In 2024, Medicaid providers in Raleigh billed a total of $13,538,241 for services within the Procedures / Professional Services category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This figure represents an 84.8% increase over 2023, when providers filed $7,323,979 in claims for similar services.
Medicaid is a public health insurance initiative operated by the states and jointly funded by the federal and state governments. It serves low-income families and individuals, seniors, children and those with disabilities, making it a major component of the national health care system.
With Medicaid funded by taxpayers, shifts in billing patterns at the local level reflect how public health care funds are distributed within communities.
The “Procedures / Professional Services” designation covers a set of Medicaid-billed services, identified by type of care provided and grouped using standard HCPCS and CPT code prefixes and ranges. Each billing code was matched to only one service category for this analysis, supporting accurate comparisons and rankings while preventing duplicate counting.
While Medicaid expenditures grew in several categories, Procedures / Professional Services was seventh in total Medicaid payments in Raleigh for 2024.
Statewide in North Carolina, the Procedures / Professional Services category also ranked seventh in 2024 by total Medicaid payments.
Examining the five-year span leading up to 2024, Medicaid payments for the Procedures / Professional Services category in Raleigh rose by $3,391,339 or 33.4%. Periods of faster growth were evident, notably with strong year-over-year gains in 2021 and 2022.
Although spending on Procedures / Professional Services was distributed throughout the city, payments were heavily concentrated in a few ZIP codes. In 2024, ZIP code 27610 saw the highest Medicaid payments for this category at $8,347,458, followed by 27616 with $3,874,352, and 27617 at $854,142. Combined, these 3 ZIP codes comprised 96.6% of all Medicaid payments in Raleigh tied to Procedures / Professional Services during the year.
Payments within the Procedures / Professional Services category were also concentrated among a small group of billing codes.
In comparison, between 2023 and 2024, Medicaid payments for Procedures / Professional Services in Raleigh rose 84.8%, while total Medicaid claims across all categories in the city increased just 0.6% during the same time frame.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached about $871.7 billion in fiscal 2023, accounting for around 18% of all national health expenditures—a significant jump from roughly $613.5 billion in 2019, before the COVID-19 pandemic.
This growth—about 40% over several years—was largely attributed to expanded program eligibility and higher utilization during and following the pandemic.
Recent federal budget measures during the Trump administration included major proposals to reduce federal Medicaid funding and overhaul the program. One such measure, the “One Big Beautiful Bill Act,” signed in 2025, is set to trim federal Medicaid spending by over $1 trillion in the next decade. It also implements work requirements and increased cost-sharing, moves that could scale back coverage and payments for some recipients. These changes could require states to shoulder a larger share of Medicaid costs, potentially curbing federal support even as program enrollment remains high.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $10,146,901 | -27.9% |
| 2021 | $10,202,207 | 0.5% |
| 2022 | $7,702,428 | -24.5% |
| 2023 | $7,323,978 | -4.9% |
| 2024 | $13,538,240 | 84.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $110,465,767 | 28.8% |
| 2 | Medicine Services and Procedures | $79,454,461 | 20.7% |
| 3 | Evaluation and Management | $65,527,277 | 17.1% |
| 4 | Alcohol and Drug Abuse Treatment | $55,204,057 | 14.4% |
| 5 | Temporary National Codes (Non-Medicare) | $18,560,448 | 4.8% |
| 6 | Pathology and Laboratory Procedures | $14,977,001 | 3.9% |
| 7 | Procedures / Professional Services | $13,538,240 | 3.5% |
| 8 | Ambulance and Other Transport Services and Supplies | $7,249,500 | 1.9% |
| 9 | Dental Services | $5,783,367 | 1.5% |
| 10 | Radiology Procedures | $4,290,817 | 1.1% |
| 11 | Drugs Administered Other than Oral Method | $2,320,213 | 0.6% |
| 12 | Surgery | $2,011,645 | 0.5% |
| 13 | Medical And Surgical Supplies | $1,371,560 | 0.4% |
| 14 | Durable Medical Equipment | $1,296,434 | 0.3% |
| 15 | Orthotic Procedures and services | $533,293 | 0.1% |
| 16 | Enteral and Parenteral Therapy | $403,879 | 0.1% |
| 17 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $250,509 | 0.1% |
| 18 | Anesthesia | $197,024 | 0.1% |
| 19 | Coronavirus Diagnostic Panel | $38,230 | <0.1% |
| 20 | Temporary Codes | $38,037 | <0.1% |
| 21 | Chemotherapy Drugs | $25,046 | <0.1% |
| 22 | Administrative, Miscellaneous and Investigational | $15,352 | <0.1% |
| 23 | Outpatient PPS | $10,001 | <0.1% |
| 24 | Vision Services | $122 | <0.1% |
| 25 | Pathology and Laboratory Services | $41 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| G0330 | Facility svs dental rehab | $8,004,924 | 12 |
| G0480 | Drug test def 1-7 classes | $3,290,654 | 219 |
| G0481 | Drug test def 8-14 classes | $1,039,137 | 129 |
| G0483 | Drug test def 22+ classes | $410,047 | 108 |
| G0378 | Hospital observation per hr | $328,080 | 48 |
| G0482 | Drug test def 15-21 classes | $250,304 | 79 |
| G0299 | Hhs/hospice of rn ea 15 min | $69,673 | 11 |
| G0463 | Hospital outpt clinic visit | $60,565 | 114 |
| G0127 | Trim nail(s) | $48,663 | 124 |
| G2211 | Complex e/m visit add on | $18,028 | 560 |
| G9919 | Scrn nd pos nd prov of rec | $7,138 | 12 |
| G0157 | Hhc pt assistant ea 15 | $3,134 | 2 |
| G0279 | Tomosynthesis, mammo | $3,087 | 8 |
| G0151 | Hhcp-serv of pt,ea 15 min | $2,893 | 3 |
| G0103 | Psa screening | $1,049 | 12 |
| G0312 | Immunize couns < 21yr 5-15 m | $461 | 1 |
| G0422 | Intens cardiac rehab w/exerc | $391 | 1 |
| G0444 | Depression screen annual | $4 | 2 |
| G0008 | Admin influenza virus vac | $0 | 1 |
| G0439 | Ppps, subseq visit | $0 | 3 |
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.
