Modesto health care providers received $44,090,727 in Medicaid payments for services grouped under the National Codes Established for State Medicaid Agencies in 2024, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 5.8% increase from 2023, during which providers billed $41,685,727 for identical services.
Medicaid, which is jointly managed by federal and state governments and operates at the state level, supplies public health insurance to low-income individuals and families, children, seniors, and people with disabilities, playing a major role in the U.S. health care landscape. More background can be found at the Commonwealth Fund.
Since Medicaid is funded through tax dollars, fluctuations in local billing amounts illustrate how community health care resources are distributed.
The “National Codes Established for State Medicaid Agencies” category contains a selection of Medicaid-billed services characterized by the nature of care delivered, organized by standardized HCPCS and CPT code groupings. This analysis used consistent prefixes and numeric code ranges to assign each billing code to a particular service category, so similar services could be reviewed together for ranking accuracy and no double counting over time.
National Codes Established for State Medicaid Agencies placed as the second-highest category for Medicaid spending in Modesto in 2024, despite Medicaid disbursements registering increases in several service groupings.
Statewide, the National Codes Established for State Medicaid Agencies ranked first by total payments to Medicaid providers in California in 2024.
Between 2019 and 2024, Medicaid payments for the National Codes Established for State Medicaid Agencies in Modesto grew by $5,304,711, or 13.7%. Certain timeframes, such as 2023 and 2020, saw more rapid growth in year-over-year spending.
Although the allocation for this care was spread throughout Modesto, a small number of ZIP codes received most of the payments in 2024: 95354 recorded $22,696,963, 95350 received $16,577,539, and 95351 saw $3,703,275. Together, these top 3 ZIP codes comprised 97.5% of all Medicaid payments connected to the National Codes Established for State Medicaid Agencies in Modesto that year.
Medicaid disbursements within this category were also heavily centered around a narrow set of billing codes.
Medicaid payments for services tied to this national codes category advanced by 5.8% in Modesto from 2023 to 2024, compared to a 7.9% increase across all Medicaid billing categories locally for the same period.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid expenses reached about $871.7 billion in fiscal year 2023. This accounted for roughly 18% of total U.S. health spending, a significant rise from around $613.5 billion in 2019, before the onset of the COVID-19 pandemic.
This growth marks an increase of about 40% within a few years, primarily driven by expanded enrollment and a rise in service usage during and after the pandemic.
Federal budget legislation passed during the Trump administration included major plans to scale back federal Medicaid funding and restructure the program. The “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to reduce federal Medicaid expenditures by more than $1 trillion over the coming decade, introducing stipulations such as work requirements and higher cost-sharing. These adjustments could curtail funding and coverage for certain recipients, shifting more fiscal obligations to the states, even as Medicaid continues to serve tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $38,786,015 | 26.1% |
| 2021 | $35,940,984 | -7.3% |
| 2022 | $27,678,813 | -23% |
| 2023 | $41,685,726 | 50.6% |
| 2024 | $44,090,727 | 5.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $44,182,025 | 18.9% |
| 2 | National Codes Established for State Medicaid Agencies | $44,090,727 | 18.8% |
| 3 | Anesthesia | $41,947,514 | 17.9% |
| 4 | Medicine Services and Procedures | $38,537,439 | 16.4% |
| 5 | Alcohol and Drug Abuse Treatment | $23,859,767 | 10.2% |
| 6 | Radiology Procedures | $8,512,087 | 3.6% |
| 7 | Pathology and Laboratory Procedures | $7,550,325 | 3.2% |
| 8 | Procedures / Professional Services | $7,522,227 | 3.2% |
| 9 | Dental Services | $7,459,382 | 3.2% |
| 10 | Ambulance and Other Transport Services and Supplies | $3,184,628 | 1.4% |
| 11 | Surgery | $2,317,230 | 1% |
| 12 | Drugs Administered Other than Oral Method | $1,443,465 | 0.6% |
| 13 | Chemotherapy Drugs | $1,100,457 | 0.5% |
| 14 | Temporary National Codes (Non-Medicare) | $1,017,696 | 0.4% |
| 15 | Temporary Codes | $574,827 | 0.2% |
| 16 | Durable Medical Equipment | $452,136 | 0.2% |
| 17 | Hearing Services | $268,201 | 0.1% |
| 18 | Administrative, Miscellaneous and Investigational | $244,505 | 0.1% |
| 19 | Medical And Surgical Supplies | $56,520 | <0.1% |
| 20 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $35,123 | <0.1% |
| 21 | Orthotic Procedures and services | $18,298 | <0.1% |
| 22 | Vision Services | $6,458 | <0.1% |
| 23 | Enteral and Parenteral Therapy | $4,704 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $32,567,837 | 1,260 |
| T1017 | Targeted case management | $8,449,396 | 122 |
| T1026 | Ped compr care pkg, per hour | $871,678 | 12 |
| T1001 | Nursing assessment/evaluatn | $643,903 | 23 |
| T2024 | Serv asmnt/care plan waiver | $528,924 | 13 |
| T2021 | Day habil waiver per 15 min | $359,733 | 8 |
| T1999 | Noc retail items andsupplies | $259,310 | 24 |
| T2033 | Res, nos waiver per diem | $229,439 | 2 |
| T2001 | N-et; patient attend/escort | $87,389 | 16 |
| T1003 | Lpn/lvn services up to 15min | $53,091 | 7 |
| T2005 | N-et; stretcher van | $18,240 | 2 |
| T2007 | Non-emer transport wait time | $10,954 | 10 |
| T1013 | Sign lang/oral interpreter | $7,988 | 7 |
| T1007 | Treatment plan development | $2,448 | 1 |
| T1014 | Telehealth transmit, per min | $390 | 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.
