Surprise Medicaid providers charged $6,931,117 in 2024 for services classified under the National Codes Established for State Medicaid Agencies, according to figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented an 18.6% growth from 2023, when claims in this category totaled $5,842,328.
Medicaid is a public insurance program administered by states and funded by both federal and state governments. It provides coverage for low-income families and individuals, seniors, children, and people with disabilities, making it a major component of the U.S. health care system.
With Medicaid funded through taxpayer dollars, fluctuations in local billing offer a window into the allocation of public health care spending within individual communities.
The “National Codes Established for State Medicaid Agencies” group includes a range of Medicaid services defined by standardized HCPCS and CPT billing codes. For this report, each code is assigned to one service category based on established code prefixes and numeric intervals, making it possible to group related services for analysis while ensuring each is counted once and allowing for accurate rankings over time.
Medicaid spending in Surprise increased across multiple groups in 2024, with the National Codes Established for State Medicaid Agencies coming in as the second-largest category by total payments.
Across Arizona, National Codes Established for State Medicaid Agencies was the largest Medicaid spending category in 2024.
From 2019 to 2024, Medicaid expenditures associated with National Codes Established for State Medicaid Agencies in Surprise grew by $4,070,494—an increase of 142.3%. The gains were particularly strong in some time frames, including notable jumps in both 2021 and 2023.
Payments for the National Codes Established for State Medicaid Agencies category, though spread through the city, were especially concentrated in specific ZIP codes. During 2024, ZIP code 85374 saw the highest total at $3,901,832. ZIP code 85378 followed with $2,563,644, and ZIP code 85388 with $465,639. The top 3 ZIP codes together accounted for 100% of Medicaid payments to this category in Surprise for the year.
Within this service group, Medicaid payments were also focused on a relatively small set of individual billing codes.
Year-over-year, Medicaid payments for National Codes Established for State Medicaid Agencies in Surprise rose by 18.6% from 2023 to 2024, outpacing the 9% increase seen across all Medicaid claim categories in the city during the same period.
The Centers for Medicare & Medicaid Services reports that combined federal and state Medicaid spending reached roughly $871.7 billion in fiscal 2023. This accounted for about 18% of total health expenditures nationwide, up significantly from approximately $613.5 billion in 2019, prior to the COVID-19 pandemic.
This increase marks around 40% growth over just a few years, largely due to expanded enrollment and rising utilization during and after the pandemic.
Recent federal budget actions under the Trump administration have introduced major proposals to reduce federal Medicaid funding and reorganize the program. The “One Big Beautiful Bill Act,” which became law in 2025, is expected to cut more than $1 trillion from federal Medicaid spending in the next decade and incorporates elements like work requirements and greater cost-sharing that could narrow funding and coverage for some recipients. These measures are set to increase financial responsibilities for states and constrain the growth of federal Medicaid contributions, despite the program continuing to cover tens of millions of American residents.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $2,860,623 | 10.5% |
| 2021 | $5,185,165 | 81.3% |
| 2022 | $4,574,099 | -11.8% |
| 2023 | $5,842,328 | 27.7% |
| 2024 | $6,931,116 | 18.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Medicine Services and Procedures | $10,674,311 | 34.5% |
| 2 | National Codes Established for State Medicaid Agencies | $6,931,116 | 22.4% |
| 3 | Evaluation and Management | $6,554,180 | 21.2% |
| 4 | Temporary National Codes (Non-Medicare) | $1,786,935 | 5.8% |
| 5 | Durable Medical Equipment | $1,632,976 | 5.3% |
| 6 | Ambulance and Other Transport Services and Supplies | $1,446,957 | 4.7% |
| 7 | Radiology Procedures | $902,577 | 2.9% |
| 8 | Surgery | $489,353 | 1.6% |
| 9 | Pathology and Laboratory Procedures | $411,114 | 1.3% |
| 10 | Dental Services | $79,756 | 0.3% |
| 11 | Drugs Administered Other than Oral Method | $47,785 | 0.2% |
| 12 | Administrative, Miscellaneous and Investigational | $18,520 | 0.1% |
| 13 | Procedures / Professional Services | $1,233 | <0.1% |
| 14 | Medical And Surgical Supplies | $0 | <0.1% |
| 14 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2021 | Day habil waiver per 15 min | $2,864,832 | 24 |
| T2016 | Habil res waiver per diem | $1,117,308 | 5 |
| T2033 | Res, nos waiver per diem | $762,953 | 11 |
| T1015 | Clinic service | $732,837 | 50 |
| T2017 | Habil res waiver 15 min | $730,309 | 21 |
| T2031 | Assist living waiver/diem | $465,639 | 11 |
| T2019 | Habil sup empl waiver 15min | $257,235 | 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.
