In 2024, Rochester Medicaid providers billed $1,283,670 for services in the Medicine Services and Procedures category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 3.8% increase compared with 2023, when providers billed $1,236,471 for these services.
Medicaid, a public insurance program managed at the state level and funded jointly by states and the federal government, serves low-income residents, older adults, children, and those with disabilities. This makes it one of the key components of the U.S. health care system.
Since Medicaid payments are taxpayer-funded, variations in local billing shed light on how public health care funds are spent within the community.
The “Medicine Services and Procedures” classification includes a collection of Medicaid-reimbursed services grouped by care type, based on standard HCPCS and CPT code ranges. For this report, every billing code was matched to a distinct service category using uniform code prefixes and ranges, ensuring analysis by group while avoiding overlap and maintaining reliable rankings over time.
Despite increases in several service categories, Medicine Services and Procedures was the third-largest Medicaid payment category in Rochester for 2024.
Statewide in New Hampshire, Medicine Services and Procedures ranked fourth for total Medicaid payments in 2024.
From 2019 through 2024, Medicaid payments for Medicine Services and Procedures in Rochester rose by $1,360,573, or 51.5%. Some periods saw accelerated growth, with notable yearly gains in 2021 and 2022.
Spending for this category, while citywide, was focused in a few ZIP codes. In 2024, ZIP code 03867 saw $1,283,669 in Medicaid payments for Medicine Services and Procedures, making up 100% of the city’s total in this category for that year.
Within Medicine Services and Procedures, a small set of billing codes accounted for most Medicaid payments.
For additional context, Medicaid payments related to Medicine Services and Procedures grew by 3.8% between 2024 and 2023, compared with a 15% change across all Medicaid claim categories within Rochester over the same timeframe.
According to the Centers for Medicare & Medicaid Services, Medicaid spending from federal and state sources totaled approximately $871.7 billion during fiscal year 2023—around 18% of total national health outlays—up sharply from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This rise equals about 40% growth in several years, driven by increased enrollment and greater use during and after the pandemic.
Major federal budget legislation during the Trump administration included several measures aiming to decrease federal Medicaid funding and restructure the program. The “One Big Beautiful Bill Act,” enacted in 2025, is projected to reduce federal Medicaid funding by over $1 trillion in the decade to come and includes new requirements like work obligations and higher participant cost-sharing, which could decrease coverage and shift certain costs to state budgets. These adjustments are expected to limit additional federal growth for Medicaid while the program continues to cover millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $2,644,243 | -2.2% |
| 2021 | $2,658,595 | 0.5% |
| 2022 | $2,123,807 | -20.1% |
| 2023 | $1,236,470 | -41.8% |
| 2024 | $1,283,669 | 3.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $2,707,975 | 34.7% |
| 2 | Alcohol and Drug Abuse Treatment | $2,591,054 | 33.2% |
| 3 | Medicine Services and Procedures | $1,283,669 | 16.5% |
| 4 | Evaluation and Management | $764,087 | 9.8% |
| 5 | Temporary National Codes (Non-Medicare) | $168,300 | 2.2% |
| 6 | Ambulance and Other Transport Services and Supplies | $98,512 | 1.3% |
| 7 | Durable Medical Equipment | $56,832 | 0.7% |
| 8 | Procedures / Professional Services | $46,662 | 0.6% |
| 9 | Pathology and Laboratory Procedures | $27,563 | 0.4% |
| 10 | Vision Services | $25,455 | 0.3% |
| 11 | Orthotic Procedures and services | $16,057 | 0.2% |
| 12 | Radiology Procedures | $10,084 | 0.1% |
| 13 | Drugs Administered Other than Oral Method | $2,191 | <0.1% |
| 14 | Temporary Codes | $657 | <0.1% |
| 15 | Surgery | $634 | <0.1% |
| 16 | Dental Services | $462 | <0.1% |
| 17 | Medical And Surgical Supplies | $131 | <0.1% |
| 18 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 90837 | Psytx w pt 60 minutes | $427,881 | 55 |
| 90847 | Family psytx w/pt 50 min | $359,178 | 30 |
| 90834 | Psytx w pt 45 minutes | $177,802 | 49 |
| 90853 | Group psychotherapy | $73,497 | 11 |
| 90846 | Family psytx w/o pt 50 min | $48,027 | 12 |
| 96374 | Ther/proph/diag inj iv push | $29,683 | 22 |
| 90791 | Psych diagnostic evaluation | $28,541 | 12 |
| 90832 | Psytx w pt 30 minutes | $24,295 | 15 |
| 97530 | Therapeutic activities | $18,435 | 7 |
| 92340 | Fit spectacles monofocal | $15,664 | 25 |
| 92014 | Compre oph exam est pt 1/> | $15,053 | 16 |
| 92507 | Tx sp lang voice comm indiv | $14,290 | 7 |
| 92015 | Determine refractive state | $8,915 | 20 |
| 97112 | Neuromuscular reeducation | $8,837 | 6 |
| 92508 | Tx sp lang voice comm group | $7,612 | 7 |
| 93005 | Electrocardiogram tracing | $6,111 | 17 |
| 96372 | Ther/proph/diag inj sc/im | $4,503 | 28 |
| 96361 | Hydrate iv infusion add-on | $3,835 | 7 |
| 96375 | Tx/pro/dx inj new drug addon | $3,559 | 9 |
| 97110 | Therapeutic exercises | $3,443 | 4 |
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.
