In 2024, Medicaid providers in Lowell billed $61,159,782 for services grouped under the National Codes Established for State Medicaid Agencies, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount reflected a 34.4% increase from the $45,515,323 billed during 2023 for the same service category.
Medicaid operates as a state-administered public health insurance program funded jointly by federal and state governments. Serving low-income populations, seniors, children, and people with disabilities, it represents a major segment of the U.S. health care system.
Since Medicaid payments rely on taxpayer funding, local billing changes reflect how public health resources are distributed in each community.
The term “National Codes Established for State Medicaid Agencies” represents a set of Medicaid-provided services characterized by care type, identified through standardized HCPCS and CPT code groupings. For analysis, every billing code was mapped to one service category using consistent code prefixes and ranges to group related services, preventing overlap and supporting accurate rankings over time.
Within Lowell, National Codes Established for State Medicaid Agencies topped all categories in Medicaid payments by total amount in 2024.
Massachusetts statewide, the National Codes Established for State Medicaid Agencies category also placed first in total Medicaid payments for 2024.
Looking at the five years leading up to 2024, Lowell’s Medicaid payments in this category rose by $10,132,155, marking a 14.2% increase. Some periods saw heightened spending growth, with significant year-over-year gains noted in 2020 and 2021.
Though these services were utilized throughout Lowell, Medicaid payments for this category were mostly concentrated within a few ZIP codes. ZIP code 01851 accounted for $46,042,865, 01852 for $12,634,055, and 01854 saw $2,482,860. Combined, these 3 ZIP codes represented the entirety of Medicaid payments tracked under National Codes Established for State Medicaid Agencies in Lowell in 2024.
Spending within this category primarily centered on a restricted set of specific billing codes.
For context, Medicaid payments for National Codes Established for State Medicaid Agencies in Lowell saw a 34.4% rise between 2024 and 2023, whereas all Medicaid claim categories experienced a 12.5% increase in the city during the same timeframe.
The Centers for Medicare & Medicaid Services report shows combined federal and state Medicaid expenditures reached around $871.7 billion for the 2023 fiscal year, making up about 18% of all U.S. health spending. That is up from roughly $613.5 billion in 2019, ahead of the COVID-19 pandemic.
This growth amounts to about 40% over several years and has been primarily driven by increased enrollment and higher usage during the pandemic and its aftermath.
Recent bipartisan budget measures during the Trump administration introduced major proposals to reduce federal Medicaid dollars and change the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, plans to reduce federal Medicaid spending by over $1 trillion over the next 10 years. This legislation brings in policies like work requirements and higher cost-sharing, potentially lowering coverage and federal funding for some beneficiaries. As a result, more financial responsibility is expected to shift to states, further restraining the growth of federal support while Medicaid still serves millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $71,291,937 | 9.7% |
| 2021 | $72,807,855 | 2.1% |
| 2022 | $51,664,100 | -29% |
| 2023 | $45,515,322 | -11.9% |
| 2024 | $61,159,781 | 34.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $61,159,781 | 41% |
| 2 | Alcohol and Drug Abuse Treatment | $21,368,263 | 14.3% |
| 3 | Temporary National Codes (Non-Medicare) | $17,154,227 | 11.5% |
| 4 | Evaluation and Management | $14,111,686 | 9.5% |
| 5 | Medicine Services and Procedures | $11,871,760 | 8% |
| 6 | Procedures / Professional Services | $5,119,443 | 3.4% |
| 7 | Ambulance and Other Transport Services and Supplies | $4,844,030 | 3.2% |
| 8 | Radiology Procedures | $4,830,397 | 3.2% |
| 9 | Surgery | $2,817,630 | 1.9% |
| 10 | Dental Services | $2,759,392 | 1.8% |
| 11 | Pathology and Laboratory Procedures | $1,650,022 | 1.1% |
| 12 | Chemotherapy Drugs | $1,030,892 | 0.7% |
| 13 | Drugs Administered Other than Oral Method | $290,702 | 0.2% |
| 14 | Anesthesia | $85,827 | 0.1% |
| 15 | Administrative, Miscellaneous and Investigational | $62,291 | <0.1% |
| 16 | Vision Services | $2,738 | <0.1% |
| 17 | Temporary Codes | $2,130 | <0.1% |
| 18 | Medical And Surgical Supplies | $1,637 | <0.1% |
| 19 | Outpatient PPS | $19 | <0.1% |
| 20 | Other Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $40,759,178 | 10 |
| T1024 | Team evaluation & management | $4,665,602 | 12 |
| T1502 | Medication admin visit | $3,721,686 | 34 |
| T1015 | Clinic service | $3,575,081 | 656 |
| T2023 | Targeted case mgmt per month | $3,112,266 | 14 |
| T2046 | Hospice long term care, r&b | $2,160,575 | 10 |
| T2003 | N-et; encounter/trip | $1,050,451 | 44 |
| T1040 | Comm bh clinic svc per diem | $915,020 | 147 |
| T1019 | Personal care ser per 15 min | $498,461 | 7 |
| T2019 | Habil sup empl waiver 15min | $357,608 | 10 |
| T1027 | Family training & counseling | $343,848 | 25 |
Note: HCPCS codes are presented for context within the category. Category totals and rankings in this article rely on standardized service groupings, not individual code billing.
Data for this story comes from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original data source is available here.
