In 2024, Medicaid providers in Raleigh billed a total of $13,538,241 for services in the Procedures / Professional Services category, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents an 84.8% increase over 2023, when claims for the same services reached $7,323,979.
Medicaid, a joint state and federal public health insurance program, provides coverage for low-income people, seniors, children, and individuals with disabilities. The program plays a substantial role in the U.S. health care system.
Shifts in Medicaid billing locally directly reflect how communities allocate taxpayer-funded health care resources.
The Procedures / Professional Services category encompasses services grouped by the type of care delivered, identified using consistent code prefixes and numeric ranges set by standardized HCPCS and CPT codes. In this report, billing codes were mapped to single service categories to ensure related services were grouped accurately, avoid duplicate counting, and maintain consistent time-based comparisons.
While total Medicaid spending rose among several service types, Procedures / Professional Services constituted the seventh-largest category for Medicaid payments in Raleigh during 2024.
Statewide in North Carolina, Procedures / Professional Services also held the seventh position for Medicaid expenses in 2024.
From 2019 through 2024, Medicaid payments for the Procedures / Professional Services category in Raleigh rose by $3,391,339, equating to a 33.4% increase. Spending saw periods of accelerated growth, with significant annual increases occurring in both 2021 and 2022.
Spending for Procedures / Professional Services was not evenly distributed but instead focused in a small group of ZIP codes within Raleigh. In 2024, ZIP codes 27610 led with payments totaling $8,347,458, followed by 27616 at $3,874,352, and 27617 with $854,142. Combined, these 3 ZIP codes represented 96.6% of Raleigh’s Medicaid spending for this service category in 2024.
A limited set of billing codes accounted for the majority of Medicaid spending within the Procedures / Professional Services category.
To compare, the 84.8% rise in Procedures / Professional Services payments in Raleigh between 2024 and 2023 far outpaced the 0.6% overall change recorded across all Medicaid claim categories in the city during the same timeframe.
According to the Centers for Medicare & Medicaid Services, state and federal Medicaid spending combined to reach $871.7 billion in fiscal year 2023. This totaled around 18% of national health spending, an increase from roughly $613.5 billion in 2019, prior to the COVID-19 pandemic.
This jump marks about 40% growth in a few short years, primarily the result of higher enrollment figures and increased service use tied to pandemic effects.
Recently passed federal budgets under the Trump administration have included major efforts to cut federal support for Medicaid and restructure the program. The “One Big Beautiful Bill Act,” signed in 2025, is expected to reduce federal Medicaid spending by more than $1 trillion over 10 years and adds policies such as work requirements and higher cost-sharing—potentially decreasing coverage and funding for certain groups. The legislation is expected to shift a larger share of program costs to states, potentially constraining further growth in federal Medicaid funding while continuing to serve tens of millions nationwide.
| 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.
