In 2024, Medicaid providers in Worcester billed $89,487,334 for services in the Temporary National Codes (Non-Medicare) category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 10.1% rise from 2023, when providers billed $81,273,704 for the same services.
Medicaid, a public health insurance program funded jointly by federal and state governments and administered by individual states, provides coverage for low-income individuals and families, seniors, children, and people with disabilities. It constitutes a major component of the U.S. health care system.
As taxpayer-funded Medicaid dollars support these payments, changes in local billing offer insight into how public health funds are distributed across the community.
The “Temporary National Codes (Non-Medicare)” category comprises Medicaid-billed services defined by care type, based on standard HCPCS and CPT code groupings. For this analysis, each billing code was categorized into a single service group using uniform code prefixes and numerical ranges, supporting examination of related services and preserving accurate rankings without double counting.
Spending rose across multiple Medicaid service categories, but Temporary National Codes (Non-Medicare) came in first by total Medicaid payments in Worcester for 2024.
Statewide in Massachusetts, Temporary National Codes (Non-Medicare) was the second highest category by total Medicaid payment in 2024.
Between 2019 and 2024, Medicaid payments for Temporary National Codes (Non-Medicare) in Worcester increased by $38,984,244, or 77.2%. Notable year-over-year surges occurred in 2023 and 2021, reflecting periods of accelerated spending growth.
Although spending in this category occurred throughout Worcester, payments were primarily concentrated in a few ZIP codes. For 2024, ZIP codes with the largest Medicaid payments for Temporary National Codes (Non-Medicare) were 01608, with $34,873,737; 01604, at $12,701,704; and 01603, at $11,645,449. These top 3 ZIP codes made up 66.2% of all such Medicaid payments in Worcester for the year.
Within the Temporary National Codes (Non-Medicare) category, a small collection of billing codes accounted for most Medicaid payments.
Medicaid payments in Worcester tied to the Temporary National Codes (Non-Medicare) category rose by 10.1% between 2024 and 2023. By comparison, all Medicaid claim categories in the city saw an overall 2.4% change during the same timeframe.
According to the Centers for Medicare & Medicaid Services, for fiscal year 2023, joint federal and state Medicaid spending reached about $871.7 billion, which was roughly 18% of total national health expenditures. This marked a significant increase from about $613.5 billion in 2019, prior to the COVID-19 pandemic.
This change represents an approximate 40% gain over a few years, primarily due to increased enrollment and utilization during and following the pandemic.
Recent federal budget laws enacted under the Trump administration included major proposals to reduce federal Medicaid funding and adjust how the program operates. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to reduce federal Medicaid spending by over $1 trillion over 10 years and impose policies such as work requirements and increased cost-sharing, potentially diminishing coverage and funding for some beneficiaries. These measures are likely to shift more financial responsibility to states and restrict further growth in federal Medicaid assistance, while the program continues to serve tens of millions of people nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $50,503,090 | -4.8% |
| 2021 | $55,709,803 | 10.3% |
| 2022 | $59,399,654 | 6.6% |
| 2023 | $81,273,703 | 36.8% |
| 2024 | $89,487,333 | 10.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Temporary National Codes (Non-Medicare) | $89,487,333 | 21.9% |
| 2 | National Codes Established for State Medicaid Agencies | $83,483,971 | 20.4% |
| 3 | Alcohol and Drug Abuse Treatment | $68,730,164 | 16.8% |
| 4 | Evaluation and Management | $47,937,586 | 11.7% |
| 5 | Medicine Services and Procedures | $34,900,677 | 8.5% |
| 6 | Procedures / Professional Services | $34,596,100 | 8.5% |
| 7 | Radiology Procedures | $12,045,160 | 2.9% |
| 8 | Pathology and Laboratory Procedures | $11,357,286 | 2.8% |
| 9 | Surgery | $7,981,459 | 2% |
| 10 | Ambulance and Other Transport Services and Supplies | $4,779,535 | 1.2% |
| 11 | Dental Services | $4,709,394 | 1.2% |
| 12 | Medical And Surgical Supplies | $3,763,843 | 0.9% |
| 13 | Drugs Administered Other than Oral Method | $3,321,573 | 0.8% |
| 14 | Durable Medical Equipment | $648,053 | 0.2% |
| 15 | Chemotherapy Drugs | $407,574 | 0.1% |
| 16 | Administrative, Miscellaneous and Investigational | $324,965 | 0.1% |
| 17 | Hearing Services | $235,413 | 0.1% |
| 18 | Temporary Codes | $156,850 | <0.1% |
| 19 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $90,329 | <0.1% |
| 20 | Orthotic Procedures and services | $70,423 | <0.1% |
| 21 | Outpatient PPS | $31,643 | <0.1% |
| 22 | Anesthesia | $29,097 | <0.1% |
| 23 | Prosthetic Procedures | $26,552 | <0.1% |
| 24 | Pathology and Laboratory Services | $4,489 | <0.1% |
| 25 | Coronavirus Diagnostic Panel | $3,160 | <0.1% |
| 26 | Enteral and Parenteral Therapy | $2,425 | <0.1% |
| 27 | Vision Services | $1,593 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| S5140 | Adult foster care per diem | $55,249,522 | 116 |
| S5102 | Adult day care per diem | $15,000,069 | 124 |
| S9485 | Crisis intervention mental h | $5,223,316 | 59 |
| S5100 | Adult daycare services 15min | $3,077,126 | 10 |
| S5130 | Homaker service nos per 15m | $2,660,243 | 96 |
| S0340 | Lifestyle mod 1st stage | $2,532,745 | 80 |
| S0341 | Lifestyle mod 2 or 3 stage | $2,486,447 | 43 |
| S5170 | Homedelivered prepared meal | $725,153 | 20 |
| S0342 | Lifestyle mod 4th stage | $476,081 | 6 |
| S5165 | Home modifications per serv | $455,301 | 10 |
| S5161 | Emer rspns sys serv permonth | $430,040 | 63 |
| S0215 | Nonemerg transp mileage | $411,229 | 40 |
| S5125 | Attendant care service /15m | $333,083 | 9 |
| S0209 | Wc van mileage per mi | $90,976 | 13 |
| S5120 | Chore services per 15 min | $89,025 | 10 |
| S0302 | Completed epsdt | $84,875 | 188 |
| S0317 | Disease mgmt per diem | $54,400 | 1 |
| S5101 | Adult day care per half day | $32,483 | 13 |
| S5131 | Homemaker service nos /diem | $30,937 | 4 |
| S9123 | Nursing care in home rn | $14,475 | 30 |
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.
