Utica Medicaid providers submitted $63,564 in claims for Outpatient PPS services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. That represents a 52.9% increase from 2023, when $41,571 was billed for these services.
Medicaid is a public health insurance program administered by the states and funded through both federal and state contributions. It provides health coverage for low-income individuals, children, seniors, and people with disabilities, and is among the largest components of the U.S. health care system.
As Medicaid expenditures rely on taxpayer support, shifts in billing volume reflect how public health funds are distributed in local communities.
The “Outpatient PPS” grouping represents a set of Medicaid-billed services identified by type of care, utilizing standardized HCPCS and CPT code clusters. For this report, each billing code is sorted into a single service group based on specific code prefixes and numerical groupings, enabling analysis of related services, minimizing duplication, and ensuring consistent rankings year over year.
Although Medicaid expenditures rose in several categories, Outpatient PPS was the 14th largest by total payments for Utica in 2024.
Statewide, Outpatient PPS ranked as the 21st category for total Medicaid payments in New York in 2024.
Between 2019 and 2024, Utica saw Medicaid payments for Outpatient PPS services climb by $24,692, or 63.5%. Some periods featured particularly strong growth, especially in 2020 and 2021.
Although spending on Outpatient PPS care occurred throughout the city, the funds were largely focused in specific ZIP codes. In 2024, ZIP code 13502 generated $63,563 in Medicaid payments tied to this category. All Outpatient PPS-related Medicaid claims in Utica for the year originated in this ZIP code, accounting for 100% of the total.
Payments for Outpatient PPS services were also highly concentrated among a few specific billing codes.
For context, Medicaid spending for Outpatient PPS in Utica jumped by 52.9% between 2023 and 2024, outpacing the 12.9% growth across all Medicaid claims categories locally during that interval.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid expenditures reached about $871.7 billion during fiscal year 2023, making up nearly 18% of total U.S. health spending. That reflects a substantial rise from $613.5 billion in 2019, before the onset of the COVID-19 pandemic.
This increase, nearly 40% in a few years, resulted largely from wider program enrollment and increased service use during and after the pandemic.
Recent federal budget measures adopted under the Trump administration feature significant reductions to federal Medicaid funding and changes to the program’s structure. The “One Big Beautiful Bill Act,” passed in 2025, is projected to cut more than $1 trillion from federal Medicaid spending over 10 years and adds work requirements and greater cost-sharing, which could lessen benefits and funding for certain populations. Such moves are expected to increase the share of Medicaid costs paid by states and curb federal funding growth, even as the program continues to serve tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $38,871 | 3430.4% |
| 2021 | $94,295 | 142.6% |
| 2022 | $62,995 | -33.2% |
| 2023 | $41,570 | -34% |
| 2024 | $63,563 | 52.9% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $31,977,705 | 39.6% |
| 2 | Evaluation and Management | $12,706,914 | 15.7% |
| 3 | Procedures / Professional Services | $9,671,436 | 12% |
| 4 | Medicine Services and Procedures | $7,598,202 | 9.4% |
| 5 | Alcohol and Drug Abuse Treatment | $7,470,470 | 9.2% |
| 6 | Radiology Procedures | $3,742,384 | 4.6% |
| 7 | Ambulance and Other Transport Services and Supplies | $2,153,817 | 2.7% |
| 8 | Pathology and Laboratory Procedures | $1,994,562 | 2.5% |
| 9 | Temporary National Codes (Non-Medicare) | $1,578,767 | 2% |
| 10 | Surgery | $1,022,356 | 1.3% |
| 11 | Dental Services | $348,362 | 0.4% |
| 12 | Vision Services | $250,380 | 0.3% |
| 13 | Durable Medical Equipment | $74,106 | 0.1% |
| 14 | Outpatient PPS | $63,563 | 0.1% |
| 15 | Drugs Administered Other than Oral Method | $56,624 | 0.1% |
| 16 | Administrative, Miscellaneous and Investigational | $50,035 | 0.1% |
| 17 | Medical And Surgical Supplies | $13,857 | <0.1% |
| 18 | Temporary Codes | $10,200 | <0.1% |
| 19 | Anesthesia | $9,161 | <0.1% |
| 20 | Pathology and Laboratory Services | $4,674 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| C1769 | Guide wire | $36,139 | 11 |
| C1713 | Anchor/screw bn/bn,tis/bn | $15,379 | 1 |
| C1894 | Intro/sheath, non-laser | $6,625 | 8 |
| C1887 | Catheter, guiding | $3,062 | 6 |
| C9290 | Inj, bupivacaine liposome | $1,292 | 1 |
| C1889 | Implant/insert device, noc | $1,034 | 11 |
| C9113 | Inj pantoprazole sodium, via | $28 | 6 |
| C1751 | Cath, inf, per/cent/midline | $0 | 1 |
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.
