The Top 10 Highest-Spending Medicaid Procedures in 2024

Medicaid is the largest payer of healthcare services in the United States, covering over 90 million enrollees. But where does that money actually go? Using our dataset of 227 million claims records spanning January 2018 through September 2024, we ranked every HCPCS procedure code by total Medicaid payments to find the answer.

The Dominant Category: Personal Care Services

The results are striking. A single procedure code — T1019 (Personal Care Services, per 15 minutes) — accounts for more Medicaid spending than any other individual code, with over $122 billion in total payments across the dataset period.

These top five codes alone represent a significant share of total Medicaid spending.

What This Tells Us About Medicaid

The dominance of T-codes (Medicaid-specific temporary codes) reveals that Medicaid's spending profile is fundamentally different from Medicare or commercial insurance. While office visits and hospital procedures dominate those payers, Medicaid's largest expenditures are in long-term services and supports (LTSS) — personal care, residential habilitation, and transportation.

Personal Care Services Breakdown

T1019 is billed in 15-minute increments, meaning the raw claims volume is enormous. A single beneficiary receiving 8 hours of personal care per day generates 32 claims per day, or roughly 960 claims per month.

Growth Over Time

Personal care spending has grown steadily since 2018:

The 2020 slowdown likely reflects pandemic disruptions to in-home care services, followed by a significant rebound in 2021.

Office Visits: The Traditional Healthcare Component

Code 99213 — the standard established patient office visit — is the highest-spending traditional medical procedure in Medicaid. At roughly $12.8 billion over the dataset period, it represents the bread-and-butter of outpatient physician services.

Key Takeaways

1. Medicaid is not primarily a medical insurance program — it's a long-term care program. The spending data makes this unmistakably clear.
2. Personal care services (T1019) dwarf all other categories, reflecting Medicaid's role as the primary funder of home and community-based services (HCBS) for elderly and disabled populations.
3. Transportation (T2003) is a top-5 expense, highlighting how Medicaid uniquely covers non-medical social determinants of health.
4. Traditional medical codes like 99213 are significant but represent a smaller share of total spending than in other insurance programs.

These patterns have major implications for state Medicaid budgets, managed care contract negotiations, and federal policy debates about Medicaid expansion and work requirements.