In 2024, providers in Apex billed $9,969,266 to Medicaid for services grouped under Medicine Services and Procedures, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 556.4% rise from 2023, when providers submitted $1,518,763 in claims for these services.
Medicaid, a public health insurance program overseen by states and funded by both federal and state governments, covers low-income families, individuals, seniors, children and people with disabilities, making it a major element of the U.S. health care system.
Since Medicaid payments use taxpayer funding, trends in local billing highlight how public health care resources are distributed in individual communities.
The “Medicine Services and Procedures” label refers to a collection of services billed through Medicaid and defined by care type, following standardized HCPCS and CPT code ranges and prefixes. For this report, each billing code was allocated to a specific service category using consistent code grouping methods to prevent double-counting and to ensure reliable tracking and ranking over time.
Medicaid expenditures rose in several service categories, but in Apex, Medicine Services and Procedures received the largest total Medicaid payments in 2024.
Statewide, North Carolina ranked this category third for Medicaid payments in 2024.
Across the five years leading up to 2024, Medicaid payments linked to Medicine Services and Procedures in Apex increased by $8,832,937, a rise of 777.3%. Some periods saw quicker spending growth, particularly in 2022 and 2020, which saw significant annual increases.
Although Medicine Services and Procedures spending was recorded throughout Apex, most payments were concentrated within a few ZIP codes. In 2024, ZIP code 27502 accounted for $9,968,857 and 27539 for $407; together, these 2 ZIP codes represented 100% of all Medicaid payments in this category for Apex in 2024.
Within the category, a small portion of individual billing codes made up most of the Medicaid payments.
For context, Medicaid payments for Medicine Services and Procedures in Apex increased 556.4% from 2023 to 2024, compared to a 132.5% increase seen across all Medicaid claim categories in the city over the same time frame.
Centers for Medicare & Medicaid Services data shows that federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023, which made up roughly 18% of total national health expenditures. This is up sharply from about $613.5 billion in 2019, before the COVID-19 pandemic.
This nearly 40% increase over a few years was mostly driven by expanded enrollment and greater use of services during and after the pandemic.
Recent federal budget laws enacted under the Trump administration introduced substantial plans to decrease federal Medicaid funding and change the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to cut over $1 trillion from federal Medicaid spending within a decade. It brings measures like work requirements and higher cost-sharing, which could reduce funding and coverage for some recipients. These changes are expected to shift more responsibility to states and slow the growth of federal Medicaid assistance, even as the program continues to cover tens of millions of Americans.
| 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 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.
