According to the U.S. Department of Health and Human Services Medicaid Provider Spending database, Springfield Medicaid providers billed $110,985,631 for services in 2024 falling within the National Codes Established for State Medicaid Agencies category. This amount reflects an 18.6% increase compared to 2023, when claims in this group totaled $93,607,032.
Medicaid is a public insurance program managed at the state level and financed jointly by federal and state governments. It provides coverage for low-income individuals and families, seniors, children, and people with disabilities, making it one of the essential pillars of the U.S. health care structure.
Since Medicaid is supported by taxpayers, trends in regional billing levels indicate how public health care resources are distributed locally.
The “National Codes Established for State Medicaid Agencies” designation includes a selection of Medicaid-billed services organized by standardized HCPCS and CPT code groupings. This report assigns each billing code to a single service category through consistent code prefixes and numeric ranges, which allows related services to be compared together while avoiding duplicate counts and maintaining accurate longitudinal rankings.
National Codes Established for State Medicaid Agencies led all categories in Springfield by total Medicaid payments in 2024 as spending rose across several service types.
The National Codes Established for State Medicaid Agencies category also ranked first for total payments in Massachusetts overall in 2024.
Medicaid payments to this service category in Springfield grew by $17,340,692, or 18.5%, over the five-year period leading to 2024. Annual spending increases were particularly notable in 2023 and 2021, reflecting periods of faster growth.
Most payments for National Codes Established for State Medicaid Agencies services in 2024 were centralized in a small set of ZIP codes. In that year, ZIP code 01103 received $61,807,906, ZIP code 01104 had $39,275,859, and ZIP code 01105 saw $7,340,461. These top three ZIP codes combined made up 97.7% of Springfield’s Medicaid payments for this service category.
Spending within the National Codes Established for State Medicaid Agencies group was further concentrated among just a few individual billing codes.
Between 2023 and 2024, Springfield saw an 18.6% increase in payments for the National Codes Established for State Medicaid Agencies category, compared to a 5.6% change across all Medicaid claim categories in the city in the same period.
According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending combined reached about $871.7 billion in fiscal year 2023, representing about 18% of total national health expenditures, up substantially from roughly $613.5 billion in 2019, before the COVID-19 pandemic.
The rise marks approximately 40% growth in just a few years, primarily due to increased enrollment and greater use of services during and after the pandemic.
Recent federal budget legislation from the Trump administration contains major proposals to reduce federal Medicaid funding and to alter the program. One example, the “One Big Beautiful Bill Act,” enacted in 2025, aims to decrease federal Medicaid spending by more than $1 trillion over the coming decade and introduces new work requirements and higher cost-sharing responsibilities that may reduce coverage and decrease funding for certain beneficiaries. These adjustments are expected to place greater fiscal responsibility on states and slow federal growth as the program continues to assist millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $93,644,938 | 1% |
| 2021 | $97,581,555 | 4.2% |
| 2022 | $60,435,416 | -38.1% |
| 2023 | $93,607,031 | 54.9% |
| 2024 | $110,985,630 | 18.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $110,985,630 | 26.6% |
| 2 | Temporary National Codes (Non-Medicare) | $69,359,074 | 16.6% |
| 3 | Alcohol and Drug Abuse Treatment | $67,270,132 | 16.1% |
| 4 | Procedures / Professional Services | $50,829,624 | 12.2% |
| 5 | Medicine Services and Procedures | $38,844,164 | 9.3% |
| 6 | Evaluation and Management | $36,950,269 | 8.9% |
| 7 | Ambulance and Other Transport Services and Supplies | $12,350,756 | 3% |
| 8 | Radiology Procedures | $8,327,385 | 2% |
| 9 | Pathology and Laboratory Procedures | $6,153,456 | 1.5% |
| 10 | Surgery | $5,677,699 | 1.4% |
| 11 | Dental Services | $4,118,081 | 1% |
| 12 | Durable Medical Equipment | $1,571,342 | 0.4% |
| 13 | Drugs Administered Other than Oral Method | $1,304,179 | 0.3% |
| 14 | Chemotherapy Drugs | $1,091,328 | 0.3% |
| 15 | Temporary Codes | $772,381 | 0.2% |
| 16 | Medical And Surgical Supplies | $724,617 | 0.2% |
| 17 | Enteral and Parenteral Therapy | $539,751 | 0.1% |
| 18 | Administrative, Miscellaneous and Investigational | $204,766 | <0.1% |
| 19 | Orthotic Procedures and services | $94,702 | <0.1% |
| 20 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $86,377 | <0.1% |
| 21 | Hearing Services | $72,232 | <0.1% |
| 22 | Coronavirus Diagnostic Panel | $7,491 | <0.1% |
| 23 | Prosthetic Procedures | $6,950 | <0.1% |
| 24 | Anesthesia | $3,622 | <0.1% |
| 25 | Pathology and Laboratory Services | $1,859 | <0.1% |
| 26 | Vision Services | $214 | <0.1% |
| 27 | Outpatient PPS | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $49,169,318 | 10 |
| T1040 | Comm bh clinic svc per diem | $31,677,511 | 404 |
| T1502 | Medication admin visit | $7,774,335 | 102 |
| T1027 | Family training & counseling | $5,630,400 | 82 |
| T1015 | Clinic service | $3,357,231 | 36 |
| T2023 | Targeted case mgmt per month | $2,969,237 | 24 |
| T2003 | N-et; encounter/trip | $2,852,427 | 47 |
| T2046 | Hospice long term care, r&b | $1,105,588 | 10 |
| T2022 | Case management, per month | $1,058,655 | 29 |
| T1019 | Personal care ser per 15 min | $693,079 | 17 |
| T2019 | Habil sup empl waiver 15min | $636,317 | 10 |
| T1024 | Team evaluation & management | $443,688 | 39 |
| T1001 | Nursing assessment/evaluatn | $396,100 | 11 |
| T4541 | Large disposable underpad | $293,862 | 12 |
| T4527 | Adult size pull-on lg | $276,142 | 12 |
| T4528 | Adult size pull-on xl | $262,056 | 12 |
| T1005 | Respite care service 15 min | $251,827 | 10 |
| T4535 | Disposable liner/shield/pad | $244,026 | 12 |
| T2031 | Assist living waiver/diem | $241,656 | 9 |
| T4526 | Adult size pull-on med | $230,753 | 12 |
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.
