Clayton Medicaid providers submitted $5,536,939 in claims for Medicine Services and Procedures in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This figure reflects a 1.1% increase from 2023, when billings for the same services totaled $5,479,149.
Medicaid, a state-administered and jointly funded public health insurance program, provides coverage for low-income individuals, families, children, seniors and those with disabilities, making it a major component of the U.S. health care system. Funding comes from both federal and state governments, according to the Commonwealth Fund.
Because Medicaid’s funding relies on taxpayers, shifts in local billing patterns reflect changes in how public health funds are used within a community.
The “Medicine Services and Procedures” category includes various Medicaid-billed services determined by type of care, with classification based on standardized HCPCS and CPT codes. Each billing code for this report was categorized into a single service group using set code prefixes and numeric ranges to maintain accuracy and prevent double counting in rankings over time.
Medicine Services and Procedures led all Medicaid categories by total spending in Clayton in 2024 amid overall payment increases across multiple services.
Statewide, Medicine Services and Procedures ranked third by total Medicaid payments in North Carolina during 2024.
Between 2019 and 2024, Medicaid spending on Medicine Services and Procedures in Clayton rose by $1,746,251—a 46.1% increase. The pace of growth accelerated during select years, particularly in 2021 and 2023, with significant year-to-year increases.
Although spending was distributed throughout Clayton, most Medicaid payments for Medicine Services and Procedures were concentrated in a few ZIP codes. In 2024, ZIP code 27520 saw $4,364,824 in payments and 27527 recorded $1,172,114. These two ZIP codes made up the entirety of Clayton’s Medicaid spending for this category that year.
A small number of individual billing codes accounted for much of the payments within the Medicine Services and Procedures category in Clayton.
To compare, between 2024 and 2023, Clayton’s Medicaid bills for this category grew by 1.1%, while citywide Medicaid claims overall changed by 9.4% over the same period.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid spending reached $871.7 billion in fiscal year 2023, or about 18% of total U.S. health expenditures—a sharp jump from $613.5 billion in 2019 prior to the COVID-19 pandemic.
This increase amounts to approximately 40% growth over several years, mainly resulting from greater enrollment and higher service use during and after the pandemic.
Recent federal budget measures from the Trump administration have introduced substantial proposals to reorganize and reduce federal Medicaid funding. For example, the “One Big Beautiful Bill Act,” which became law in 2025, is expected to reduce federal Medicaid outlays by over $1 trillion in the next decade. The act also adds new requirements such as mandatory work and higher cost-sharing, potentially narrowing access and pushing more costs to states as federal support growth slows while the program continues to serve millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $3,790,687 | 0.1% |
| 2021 | $4,924,343 | 29.9% |
| 2022 | $4,339,058 | -11.9% |
| 2023 | $5,479,149 | 26.3% |
| 2024 | $5,536,939 | 1.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Medicine Services and Procedures | $5,536,939 | 46.3% |
| 2 | Alcohol and Drug Abuse Treatment | $4,031,980 | 33.7% |
| 3 | Evaluation and Management | $1,964,104 | 16.4% |
| 4 | Dental Services | $282,937 | 2.4% |
| 5 | Durable Medical Equipment | $58,451 | 0.5% |
| 6 | Temporary National Codes (Non-Medicare) | $42,007 | 0.4% |
| 7 | Pathology and Laboratory Procedures | $23,277 | 0.2% |
| 8 | Medical And Surgical Supplies | $19,566 | 0.2% |
| 9 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $3,112 | <0.1% |
| 10 | Surgery | $2,624 | <0.1% |
| 11 | Radiology Procedures | $274 | <0.1% |
| 12 | Procedures / Professional Services | $16 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 92507 | Tx sp lang voice comm indiv | $2,384,693 | 313 |
| 99509 | Home visit day life activity | $1,293,313 | 24 |
| 97153 | Adaptive behavior tx by tech | $790,755 | 12 |
| 97530 | Therapeutic activities | $522,396 | 58 |
| 97155 | Adapt behavior tx phys/qhp | $228,353 | 19 |
| 90999 | Unlisted dialysis procedure | $70,238 | 10 |
| 90837 | Psytx w pt 60 minutes | $66,212 | 14 |
| 90471 | Immunization admin | $33,735 | 67 |
| 97156 | Fam adapt bhv tx gdn phy/qhp | $33,637 | 16 |
| 90472 | Immunization admin each add | $32,223 | 40 |
| 92523 | Speech sound lang comprehen | $27,221 | 11 |
| 96110 | Developmental screen w/score | $15,637 | 50 |
| 92340 | Fit spectacles monofocal | $9,045 | 21 |
| 92370 | Rpr&refitg spect xcp aphakia | $4,282 | 21 |
| 94060 | Evaluation of wheezing | $3,230 | 8 |
| 90791 | Psych diagnostic evaluation | $3,205 | 2 |
| 96127 | Brief emotional/behav assmt | $2,651 | 27 |
| 94664 | Demo&/eval pt use inhaler | $2,237 | 8 |
| 92551 | Pure tone hearing test air | $2,057 | 38 |
| 94618 | Pulmonary stress testing | $1,962 | 8 |
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.
