Pottstown Medicaid providers billed a total of $10,091,081 for services under the National Codes Established for State Medicaid Agencies classification in 2024, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This figure reflects a 59.6% rise from 2023, when providers submitted $6,322,351 in claims for the same category.
Medicaid, the public health insurance program administered by states and funded by both federal and state governments, offers coverage to low-income people and families, seniors, children, and those with disabilities, making it a major component of the U.S. health care system.
Since Medicaid payments are financed through taxpayer dollars, shifts in local billing volumes indicate how public health funds are distributed in a community.
The “National Codes Established for State Medicaid Agencies” group includes Medicaid services identified by type of care and organized based on HCPCS and CPT code groupings. The analysis assigned each billing code to one service category using unified code prefixes and number ranges, grouping services for review while avoiding double counting and preserving rankings over time.
While several service categories experienced higher Medicaid spending, National Codes Established for State Medicaid Agencies led all categories in Pottstown for total Medicaid payments in 2024.
Across Pennsylvania, the National Codes Established for State Medicaid Agencies group took the second spot in total Medicaid payments in 2024.
From 2019 to 2024, Medicaid payments in Pottstown linked to the National Codes Established for State Medicaid Agencies climbed by $6,177,408, or 157.8%. Certain periods saw accelerated spending growth, notably during 2021 and 2020.
Although care in the National Codes Established for State Medicaid Agencies category was accessed citywide, Medicaid payments were focused in a small number of ZIP codes. In 2024, ZIP code 19465 accounted for $8,930,593, and 19464 represented $1,160,487. Together, these 2 ZIP codes made up all Medicaid payments in this category for Pottstown during 2024.
Payments within the National Codes Established for State Medicaid Agencies group were concentrated among a small selection of billing codes.
To compare, Medicaid payments linked to this group in Pottstown rose 59.6% from 2023 to 2024, while all Medicaid claim categories in Pottstown increased by 17.4% over the same period.
According to the Centers for Medicare & Medicaid Services, nationwide Medicaid spending—federal and state combined—reached about $871.7 billion in fiscal year 2023. This represented nearly 18% of all national health spending, up from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This growth of around 40% over a few years was largely due to greater enrollment and increased use of services during and after the pandemic.
Recent federal budget actions under the Trump administration have put forward notable reductions in federal Medicaid funding and program changes. For instance, the “One Big Beautiful Bill Act,” which became law in 2025, is expected to reduce federal Medicaid spending by over $1 trillion in the next decade and includes provisions such as work requirements and heightened cost-sharing. These measures could narrow coverage and funding for some recipients, shifting more financial responsibility to states and curbing federal Medicaid spending growth, even as the program covers tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $3,913,673 | 18.1% |
| 2021 | $5,665,941 | 44.8% |
| 2022 | $6,097,653 | 7.6% |
| 2023 | $6,322,351 | 3.7% |
| 2024 | $10,091,081 | 59.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $10,091,081 | 44.3% |
| 2 | Medicine Services and Procedures | $4,649,048 | 20.4% |
| 3 | Evaluation and Management | $2,980,598 | 13.1% |
| 4 | Temporary National Codes (Non-Medicare) | $2,017,784 | 8.9% |
| 5 | Alcohol and Drug Abuse Treatment | $1,546,065 | 6.8% |
| 6 | Ambulance and Other Transport Services and Supplies | $858,058 | 3.8% |
| 7 | Procedures / Professional Services | $174,111 | 0.8% |
| 8 | Vision Services | $164,462 | 0.7% |
| 9 | Dental Services | $143,689 | 0.6% |
| 10 | Durable Medical Equipment | $48,007 | 0.2% |
| 11 | Orthotic Procedures and services | $38,627 | 0.2% |
| 12 | Pathology and Laboratory Procedures | $36,380 | 0.2% |
| 13 | Surgery | $12,002 | 0.1% |
| 14 | Medical And Surgical Supplies | $2,410 | <0.1% |
| 15 | Radiology Procedures | $96 | <0.1% |
| 16 | Temporary Codes | $14 | <0.1% |
| 17 | Drugs Administered Other than Oral Method | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $10,091,081 | 343 |
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.
