In 2024, Medicaid providers in Boston submitted $366,238 in claims for services grouped under the Administrative, Miscellaneous and Investigational category, based on information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This figure reflects a 19.2% increase compared to 2023, when claims for these services amounted to $307,132.
Medicaid is a government-backed health insurance program managed by each state in partnership with the federal government for funding purposes. It provides coverage for eligible low-income individuals and families, seniors, children, and people with disabilities, making it a major element of the national health care system.
Since Medicaid payments are funded with public dollars, fluctuations in local billing reveal patterns in the distribution of health care resources within the community.
The “Administrative, Miscellaneous and Investigational” category encompasses a range of Medicaid-billed services determined by the nature of care provided and categorized according to specific HCPCS and CPT code groupings. In this analysis, billing codes were sorted into single service groups using systematic code prefixes and numerical boundaries. This method groups similar services together, avoids duplicate counts, and allows for accurate year-to-year comparisons.
While multiple service groupings saw increased Medicaid spending, the Administrative, Miscellaneous and Investigational category was 17th by total Medicaid payments in 2024 within Boston.
Statewide in Massachusetts, this category also ranked 17th in terms of total Medicaid spending for 2024.
Between 2019 and 2024, Boston recorded an increase of $183,243, or 100.1%, in Medicaid spending tied to the Administrative, Miscellaneous and Investigational group. Certain periods, notably 2021 and 2022, saw accelerated year-over-year growth in these services.
Spending across this category was spread citywide but highly concentrated in a handful of ZIP codes. The highest 2024 Medicaid payments for Administrative, Miscellaneous and Investigational services were in ZIP code 02108 at $150,204; 02115 with $56,718; and 02215 with $55,721. These three ZIP codes represented 71.7% of Boston’s Medicaid spending within the category that year.
A small number of individual billing codes within the Administrative, Miscellaneous and Investigational category comprised the majority of processed Medicaid payments.
Compared to the previous year, Medicaid spending for Administrative, Miscellaneous and Investigational services in Boston grew by 19.2% from 2023 to 2024, while Medicaid claims overall across the city rose by 12.7% over the same time frame.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled approximately $871.7 billion in fiscal 2023, which equaled about 18% of national health care expenditures—an increase from the roughly $613.5 billion reported for 2019 before the COVID-19 pandemic.
This growth is equivalent to about a 40% jump within a few years, due mainly to enrollment expansion and heightened utilization during and after the pandemic.
Federal legislation enacted during the Trump administration included major proposals to decrease federal Medicaid outlays and restructure program funding. For instance, the “One Big Beautiful Bill Act,”, signed in 2025, is projected to reduce federal Medicaid funding by more than $1 trillion over a decade. It establishes new requirements, such as work mandates and higher cost-sharing. These modifications are expected to shift additional Medicaid program costs to states and moderate the pace of federal funding, even as the program continues coverage for tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $182,995 | -11.4% |
| 2021 | $269,855 | 47.5% |
| 2022 | $310,792 | 15.2% |
| 2023 | $307,131 | -1.2% |
| 2024 | $366,238 | 19.2% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $191,607,093 | 25.1% |
| 2 | Evaluation and Management | $158,026,981 | 20.7% |
| 3 | Alcohol and Drug Abuse Treatment | $92,911,869 | 12.2% |
| 4 | Medicine Services and Procedures | $85,351,169 | 11.2% |
| 5 | Surgery | $43,321,894 | 5.7% |
| 6 | Radiology Procedures | $40,526,562 | 5.3% |
| 7 | Temporary National Codes (Non-Medicare) | $35,684,565 | 4.7% |
| 8 | Pathology and Laboratory Procedures | $31,729,661 | 4.2% |
| 9 | Chemotherapy Drugs | $24,633,075 | 3.2% |
| 10 | Drugs Administered Other than Oral Method | $20,825,301 | 2.7% |
| 11 | Procedures / Professional Services | $20,640,682 | 2.7% |
| 12 | Ambulance and Other Transport Services and Supplies | $8,810,621 | 1.2% |
| 13 | Dental Services | $4,002,065 | 0.5% |
| 14 | Temporary Codes | $3,996,692 | 0.5% |
| 15 | Hearing Services | $463,657 | 0.1% |
| 16 | Anesthesia | $393,850 | 0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $366,238 | <0.1% |
| 18 | Orthotic Procedures and services | $330,820 | <0.1% |
| 19 | Coronavirus Diagnostic Panel | $125,497 | <0.1% |
| 20 | Vision Services | $99,225 | <0.1% |
| 21 | Pathology and Laboratory Services | $82,901 | <0.1% |
| 22 | Outpatient PPS | $35,307 | <0.1% |
| 23 | Medical And Surgical Supplies | $18,116 | <0.1% |
| 24 | Prosthetic Procedures | $3,185 | <0.1% |
| 25 | Durable Medical Equipment | $0 | <0.1% |
| 25 | Other Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| A9280 | Alert device, noc | $144,804 | 11 |
| A9552 | F18 fdg | $85,952 | 76 |
| A9585 | Gadobutrol injection | $79,543 | 112 |
| A9575 | Inj gadoterate meglumi 0.1ml | $42,343 | 119 |
| A9595 | Piflu f-18, dia 1 millicurie | $6,277 | 1 |
| A9279 | Monitoring feature/devicenoc | $5,400 | 8 |
| A9500 | Tc99m sestamibi | $1,026 | 63 |
| A9579 | Gad-base mr contrast nos,1ml | $295 | 12 |
| A9503 | Tc99m medronate | $272 | 2 |
| A9609 | F18 fdg, 15 millicuries | $195 | 22 |
| A9581 | Gadoxetate disodium inj | $125 | 8 |
| A9502 | Tc99m tetrofosmin | $0 | 1 |
| A9555 | Rb82 rubidium | $0 | 9 |
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.
