Providers in Montrose billed $4,902,833 to Medicaid for services under the National Codes Established for State Medicaid Agencies category in 2024, according to information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represented a 15.4% jump from the $4,250,369 reported for the same category in 2023.
Medicaid is a state-run public health insurance program, financed by both state and federal governments. It provides coverage for low-income adults and children, seniors, and those with disabilities, making it one of the largest components of the nation’s health care system.
Since Medicaid payments draw from tax revenue, fluctuations in billing show how a community allocates its public health care resources.
The “National Codes Established for State Medicaid Agencies” group is based on a set of Medicaid-billed services defined by the service type, using standardized HCPCS and CPT codes. Each code in this analysis was assigned to one service group by code prefix and number range to ensure services were classified together without duplication, supporting coherent tracking and ranking over time.
Montrose saw the National Codes Established for State Medicaid Agencies lead all service categories in total Medicaid payments for 2024.
Across Colorado, the National Codes Established for State Medicaid Agencies category also ranked first by payment amount in 2024.
In the five years ending in 2024, Medicaid payments in Montrose for this category grew by $702,328, or 16.7%. Certain years, such as 2020 and 2022, saw sharper increases in spending.
Although payments for these services were spread through Montrose, they were primarily concentrated in a small number of ZIP codes. In 2024, ZIP code 81401 saw the most spending in this category, with $4,902,833. That single ZIP code accounted for 100% of Medicaid payments in the National Codes Established for State Medicaid Agencies category in Montrose for the year.
Within the category, a handful of individual billing codes made up most Medicaid payments.
From 2023 to 2024, Medicaid payments for the National Codes Established for State Medicaid Agencies in Montrose increased 15.4%, compared with a 12.1% overall increase for all Medicaid claim categories in the city during the same timeframe.
According to the Centers for Medicare & Medicaid Services, federal and state Medicaid expenses reached approximately $871.7 billion in fiscal year 2023, making up about 18% of all health expenditures in the U.S., a substantial rise from $613.5 billion in 2019, before the pandemic.
This marks close to 40% growth in just a few years, largely driven by expanded coverage and increased service use during and following the pandemic.
Recent federal budget actions under the Trump administration have brought substantial proposals to lower federal Medicaid spending and alter the program’s structure. The “One Big Beautiful Bill Act,” signed in 2025, is set to reduce federal Medicaid funding by more than $1 trillion over 10 years and adds work requirements and higher cost-sharing, potentially reducing coverage and funding for certain beneficiaries. These measures are expected to push additional costs to state governments and restrict further federal Medicaid increases, while the program still covers tens of millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,200,504 | 18.5% |
| 2021 | $4,007,618 | -4.6% |
| 2022 | $4,196,338 | 4.7% |
| 2023 | $4,250,368 | 1.3% |
| 2024 | $4,902,833 | 15.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $4,902,833 | 34.5% |
| 2 | Evaluation and Management | $2,746,650 | 19.3% |
| 3 | Alcohol and Drug Abuse Treatment | $2,346,685 | 16.5% |
| 4 | Medicine Services and Procedures | $1,572,188 | 11.1% |
| 5 | Dental Services | $894,054 | 6.3% |
| 6 | Vision Services | $482,628 | 3.4% |
| 7 | Temporary National Codes (Non-Medicare) | $475,086 | 3.3% |
| 8 | Durable Medical Equipment | $265,702 | 1.9% |
| 9 | Ambulance and Other Transport Services and Supplies | $200,808 | 1.4% |
| 10 | Pathology and Laboratory Procedures | $114,956 | 0.8% |
| 11 | Surgery | $81,358 | 0.6% |
| 12 | Radiology Procedures | $53,477 | 0.4% |
| 13 | Medical And Surgical Supplies | $47,846 | 0.3% |
| 14 | Procedures / Professional Services | $10,401 | 0.1% |
| 15 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $4,643 | <0.1% |
| 16 | Drugs Administered Other than Oral Method | $29 | <0.1% |
| 17 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $1,812,519 | 11 |
| T1019 | Personal care ser per 15 min | $877,541 | 12 |
| T2023 | Targeted case mgmt per month | $695,330 | 11 |
| T2021 | Day habil waiver per 15 min | $675,921 | 14 |
| T2003 | N-et; encounter/trip | $419,054 | 11 |
| T2031 | Assist living waiver/diem | $150,744 | 5 |
| T2024 | Serv asmnt/care plan waiver | $141,019 | 11 |
| T2019 | Habil sup empl waiver 15min | $75,931 | 11 |
| T1017 | Targeted case management | $54,767 | 20 |
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.
