According to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database, Medicaid providers in Sterling billed $30,325,166 for services under the National Codes Established for State Medicaid Agencies in 2024. This was up 34.9% from 2023, when spending for this category reached $22,485,315.
Medicaid—a public health insurance initiative funded jointly by state and federal governments and managed by the states—provides coverage for low-income people, seniors, children, and individuals living with disabilities. It is a cornerstone of the U.S. health system.
Because taxpayer funding supports Medicaid payments, shifts in billing amounts locally indicate how public resources for health care are distributed within communities.
The “National Codes Established for State Medicaid Agencies” category includes Medicaid-billed services, grouped by care type and defined using standardized HCPCS and CPT code prefixes and ranges. For purposes of this analysis, each billing code relates to a single service group, allowing for comparisons and trend analysis without double-counting or rank inconsistencies.
Although Medicaid spending was higher across several service areas, the National Codes Established for State Medicaid Agencies category ranked first by total payments in Sterling in 2024.
Statewide in Virginia, the National Codes Established for State Medicaid Agencies also led for overall Medicaid payments in 2024.
From five years earlier to 2024, Sterling’s Medicaid payments connected to this category grew by $21,690,611, which amounts to a 251.2% increase. There were particularly strong year-over-year gains seen in 2022 and 2023.
While spending was distributed across the city, most Medicaid payments for these services came from just a few ZIP codes. For 2024, the top ZIP codes were 20164 ($22,384,186), 20166 ($6,073,761), and 20165 ($1,867,217). Together, these 3 areas comprised 100% of local Medicaid payments for this group during the year.
Only a limited number of billing codes accounted for the majority of Medicaid payments within the National Codes Established for State Medicaid Agencies group.
For context, between 2024 and 2023, Sterling’s Medicaid payments tied to this group grew 34.9%, while payments across all claim categories rose by 38.4% over the same period.
According to the Centers for Medicare & Medicaid Services, joint federal and state Medicaid spending was about $871.7 billion for the 2023 fiscal year, making up around 18% of total national health costs. In 2019, prior to the COVID-19 pandemic, that figure stood at $613.5 billion.
This jump represents about 40% growth in only a few years, largely fueled by increased enrollment and higher utilization during and after the pandemic era.
Recent federal budget measures enacted during the Trump administration feature major proposals to curtail federal Medicaid outlays and alter the program. For instance, the “One Big Beautiful Bill Act,” approved in 2025, is expected to trim over $1 trillion from federal Medicaid funding over the next 10 years and introduce requirements like work mandates and greater cost-sharing, potentially reducing beneficiary coverage and state allocations. As a result, states are expected to assume a larger funding burden with federal spending growth restricted, even though the program serves tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $8,634,554 | 9.2% |
| 2021 | $10,792,742 | 25% |
| 2022 | $17,263,256 | 60% |
| 2023 | $22,485,314 | 30.2% |
| 2024 | $30,325,166 | 34.9% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $30,325,166 | 77.1% |
| 2 | Temporary National Codes (Non-Medicare) | $4,166,834 | 10.6% |
| 3 | Alcohol and Drug Abuse Treatment | $2,831,128 | 7.2% |
| 4 | Medicine Services and Procedures | $1,101,818 | 2.8% |
| 5 | Evaluation and Management | $763,453 | 1.9% |
| 6 | Pathology and Laboratory Procedures | $126,944 | 0.3% |
| 7 | Vision Services | $10,776 | <0.1% |
| 8 | Ambulance and Other Transport Services and Supplies | $9,822 | <0.1% |
| 9 | Radiology Procedures | $4,251 | <0.1% |
| 10 | Procedures / Professional Services | $2,935 | <0.1% |
| 11 | Surgery | $18 | <0.1% |
| 12 | Dental Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $23,969,391 | 121 |
| T1005 | Respite care service 15 min | $3,233,370 | 80 |
| T1003 | Lpn/lvn services up to 15min | $3,088,729 | 10 |
| T2005 | N-et; stretcher van | $33,675 | 6 |
| T2049 | N-et; stretcher van, mileage | $0 | 6 |
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.
