In 2024, Medicaid providers in Apex billed $9,969,266 for services included in the Medicine Services and Procedures category, based on information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represented a 556.4% jump over 2023, when providers filed $1,518,763 in claims for the same category.
Medicaid, a public health insurance program, is operated by each state and financed by both federal and state governments. It serves as coverage for low-income families and individuals, seniors, children, and people with disabilities, making it one of the nation’s largest health care programs.
Because Medicaid dollars originate from taxpayers, shifts in local billing illustrate how public health funding is distributed throughout a community.
The “Medicine Services and Procedures” label includes a group of Medicaid-billed services defined by type of care, standardized under HCPCS and CPT code ranges. For this article, billing codes were assigned to one service category each using established prefixes and number ranges to allow analysis without overlap or duplication, ensuring accurate year-by-year comparisons.
While multiple service groups saw growth, Medicine Services and Procedures was the top-ranked category for Medicaid payments in Apex in 2024.
Statewide, North Carolina ranked the Medicine Services and Procedures category third in total Medicaid payments for 2024.
Looking at the five years prior to 2024, Medicaid payments for the Medicine Services and Procedures category in Apex increased by $8,832,937—a rise of 777.3%. Notable increases occurred in certain periods, including 2022 and 2020.
Spending distribution across Apex showed that payments in the Medicine Services and Procedures category were concentrated in a handful of ZIP codes. In 2024, ZIP code 27502 accounted for $9,968,857, while 27539 had $407. Together, those two ZIP codes made up 100% of Medicaid payments within this category in Apex for the year.
Spending was further concentrated within a small set of individual billing codes in the Medicine Services and Procedures group.
When comparing year over year, Medicaid payments for these services in Apex rose by 556.4% from 2023 to 2024, while the increase for all Medicaid claim categories in the city was 132.5% in the same timeframe.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023—roughly 18% of all U.S. health expenditures—up sharply from around $613.5 billion in 2019 prior to the COVID-19 pandemic.
This increase is approximately 40% over several years, fueled largely by higher enrollment and increased utilization during and after the pandemic.
Recent federal budget measures under the Trump administration have included major proposals to lower federal Medicaid funding and alter the program’s structure. As an example, the “One Big Beautiful Bill Act,” enacted in 2025, is estimated to reduce federal Medicaid funding by more than $1 trillion over 10 years. The law introduces work requirements and higher cost-sharing, which could decrease funding and coverage for some, with costs shifting to the states and federal expansion potentially slowing even as the program continues to serve millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,136,329 | 16.4% |
| 2021 | $1,087,339 | -4.3% |
| 2022 | $1,335,576 | 22.8% |
| 2023 | $1,518,762 | 13.7% |
| 2024 | $9,969,265 | 556.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Medicine Services and Procedures | $9,969,265 | 67.1% |
| 2 | National Codes Established for State Medicaid Agencies | $2,083,850 | 14% |
| 3 | Durable Medical Equipment | $1,278,809 | 8.6% |
| 4 | Evaluation and Management | $581,322 | 3.9% |
| 5 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $389,989 | 2.6% |
| 6 | Alcohol and Drug Abuse Treatment | $372,281 | 2.5% |
| 7 | Temporary National Codes (Non-Medicare) | $113,695 | 0.8% |
| 8 | Dental Services | $55,223 | 0.4% |
| 9 | Pathology and Laboratory Procedures | $2,413 | <0.1% |
| 10 | Pathology and Laboratory Services | $635 | <0.1% |
| 11 | Surgery | $553 | <0.1% |
| 12 | Procedures / Professional Services | $111 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 97153 | Adaptive behavior tx by tech | $7,371,314 | 28 |
| 97155 | Adapt behavior tx phys/qhp | $811,933 | 25 |
| 97530 | Therapeutic activities | $707,264 | 135 |
| 92507 | Tx sp lang voice comm indiv | $687,820 | 94 |
| 90837 | Psytx w pt 60 minutes | $173,820 | 45 |
| 97151 | Bhv id assmt by phys/qhp | $107,037 | 10 |
| 97156 | Fam adapt bhv tx gdn phy/qhp | $56,519 | 17 |
| 92523 | Speech sound lang comprehen | $21,222 | 9 |
| 90999 | Unlisted dialysis procedure | $13,917 | 4 |
| 90834 | Psytx w pt 45 minutes | $7,116 | 3 |
| 90460 | Im admin 1st/only component | $4,192 | 4 |
| 90791 | Psych diagnostic evaluation | $2,121 | 1 |
| 92340 | Fit spectacles monofocal | $1,651 | 4 |
| 97750 | Physical performance test | $1,126 | 1 |
| 92370 | Rpr&refitg spect xcp aphakia | $548 | 4 |
| 96110 | Developmental screen w/score | $470 | 3 |
| 96127 | Brief emotional/behav assmt | $378 | 4 |
| 90471 | Immunization admin | $291 | 7 |
| 90661 | Cciiv3 vac abx fr 0.5 ml im | $249 | 1 |
| 92551 | Pure tone hearing test air | $148 | 5 |
Note: HCPCS codes are included to provide context within the broader category. Totals and rankings in this article are based on the standardized service groupings rather than each unique billing code.
Data referenced in this article comes from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Original data is available here.
