Seattle Medicaid providers billed $37,558,341 in 2024 for services within the National Codes Established for State Medicaid Agencies category, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents a 4.1% increase from 2023, when total claims for the same services reached $36,078,684.
Medicaid is a state-administered public health insurance program jointly funded by federal and state governments. It provides coverage for eligible low-income individuals and families, senior citizens, children, and those with disabilities, making it a significant component of the health care system in the United States.
Taxpayer funds used for Medicaid payments mean changes to local billing reflect shifts in how communities allocate public health care spending.
The “National Codes Established for State Medicaid Agencies” category encompasses a set of Medicaid-billed services identified by care type, defined using standardized HCPCS and CPT groupings. For purposes of this analysis, each billing code was placed within a single service group using established code prefixes and numeric ranges. This method allows relevant services to be tracked together while preventing double counting and ensuring accurate rankings across years.
Although Medicaid spending increased in several service groupings, National Codes Established for State Medicaid Agencies was the third largest service category by payment amount in Seattle for 2024.
Statewide in Washington, National Codes Established for State Medicaid Agencies led all service categories by total Medicaid payments in 2024.
Between 2019 and 2024, Medicaid payments in Seattle connected to the National Codes Established for State Medicaid Agencies category rose by $4,414,873, representing an increase of 13.3%. Certain years saw higher growth rates, particularly in 2021 and 2022.
Though care in this category was provided throughout Seattle, most Medicaid spending was concentrated within a few ZIP codes. In 2024, the highest Medicaid payments tied to National Codes Established for State Medicaid Agencies were recorded in ZIP code 98104 ($19,584,272), 98118 ($4,835,932), and 98144 ($3,057,238). Combined, these top 3 ZIP codes represented 73.2% of all Medicaid payments linked to this category in Seattle during 2024.
Within National Codes Established for State Medicaid Agencies, Medicaid payments focused on a small number of billing codes.
For reference, Medicaid payments in Seattle related to this category increased by 4.1% between 2024 and 2023. By comparison, all Medicaid claim categories in the city rose by 7.9% during the same time frame.
According to the Centers for Medicare & Medicaid Services, joint federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023, making up approximately 18% of overall national health care expenditures. That marks a sharp increase from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This translates to growth of about 40% over a few years, fueled mostly by rising enrollment and greater utilization during and following the pandemic.
Federal budget measures under the Trump administration introduced substantial proposals to limit federal Medicaid funding and change the program’s structure. The “One Big Beautiful Bill Act,” signed into law in 2025, is set to reduce federal Medicaid spending by more than $1 trillion over a decade. It brings new policies, such as work requirements and more cost-sharing, which could narrow coverage and funding for certain beneficiaries. These reforms will shift additional costs to states and slow federal Medicaid spending growth, even as the program remains a major source of health coverage for millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $33,143,468 | -20.8% |
| 2021 | $41,467,699 | 25.1% |
| 2022 | $38,429,775 | -7.3% |
| 2023 | $36,078,683 | -6.1% |
| 2024 | $37,558,340 | 4.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $55,202,866 | 19.6% |
| 2 | Pathology and Laboratory Procedures | $47,299,387 | 16.8% |
| 3 | National Codes Established for State Medicaid Agencies | $37,558,340 | 13.3% |
| 4 | Drugs Administered Other than Oral Method | $29,642,886 | 10.5% |
| 5 | Medicine Services and Procedures | $25,233,132 | 8.9% |
| 6 | Procedures / Professional Services | $19,427,782 | 6.9% |
| 7 | Alcohol and Drug Abuse Treatment | $16,464,492 | 5.8% |
| 8 | Radiology Procedures | $13,460,416 | 4.8% |
| 9 | Surgery | $10,299,333 | 3.7% |
| 10 | Temporary National Codes (Non-Medicare) | $8,943,731 | 3.2% |
| 11 | Dental Services | $5,098,567 | 1.8% |
| 12 | Chemotherapy Drugs | $4,902,989 | 1.7% |
| 13 | Ambulance and Other Transport Services and Supplies | $4,396,423 | 1.6% |
| 14 | Temporary Codes | $2,218,182 | 0.8% |
| 15 | Medical And Surgical Supplies | $775,013 | 0.3% |
| 16 | Durable Medical Equipment | $427,741 | 0.2% |
| 17 | Outpatient PPS | $372,042 | 0.1% |
| 18 | Pathology and Laboratory Services | $170,913 | 0.1% |
| 19 | Anesthesia | $122,878 | <0.1% |
| 20 | Administrative, Miscellaneous and Investigational | $11,946 | <0.1% |
| 21 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $11,529 | <0.1% |
| 22 | Vision Services | $9,791 | <0.1% |
| 23 | Miscellaneous Medical Services | $3,561 | <0.1% |
| 24 | Prosthetic Procedures | $1,713 | <0.1% |
| 25 | Orthotic Procedures and services | $1,570 | <0.1% |
| 26 | Coronavirus Diagnostic Panel | $261 | <0.1% |
| 27 | Enteral and Parenteral Therapy | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $33,657,717 | 1,680 |
| T2022 | Case management, per month | $949,917 | 26 |
| T4527 | Adult size pull-on lg | $447,873 | 15 |
| T4526 | Adult size pull-on med | $386,991 | 23 |
| T4541 | Large disposable underpad | $347,440 | 22 |
| T4535 | Disposable liner/shield/pad | $329,228 | 21 |
| T4528 | Adult size pull-on xl | $179,351 | 12 |
| T4537 | Reusable underpad bed size | $174,783 | 12 |
| T1017 | Targeted case management | $148,260 | 200 |
| T1002 | Rn services up to 15 minutes | $129,465 | 117 |
| T4544 | Adlt disp und/pull on abv xl | $125,557 | 12 |
| T2035 | Utility services waiver | $91,147 | 16 |
| T4543 | Adult disp brief/diap abv xl | $86,147 | 12 |
| T4523 | Adult size brief/diaper lg | $84,149 | 12 |
| T1041 | Comm bh clinic svc per month | $70,772 | 6 |
| T4524 | Adult size brief/diaper xl | $61,516 | 12 |
| T1027 | Family training & counseling | $59,668 | 17 |
| T4525 | Adult size pull-on sm | $57,751 | 12 |
| T1007 | Treatment plan development | $46,949 | 6 |
| T4522 | Adult size brief/diaper med | $43,193 | 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.
