In 2024, Medicaid providers in Milwaukee submitted $1,599,404 in claims for administrative, miscellaneous and investigational services, according to data reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 241.7% rise from 2023, when claims for these services totaled $468,017.
Medicaid, a public health insurance initiative managed by states and jointly financed by federal and state funds, covers low-income residents, the elderly, children, and people with disabilities—making it one of the largest components of the nation’s health care system.
As Medicaid payments are taxpayer-funded, shifts in local billing provide insight into how public health care resources are distributed at the community level.
The “Administrative, Miscellaneous and Investigational” classification consists of Medicaid-billed services based on the type of care delivered, with assignments derived from standardized HCPCS and CPT code groupings. This analysis categorized each billing code in a single service category using code prefixes and numeric intervals to group related services, ensuring no double counting and consistent ranking comparisons over time.
While Medicaid costs grew across a variety of categories, administrative, miscellaneous and investigational expenses ranked 13th by total Medicaid payments among all service categories in Milwaukee for 2024.
Statewide, this same category placed 14th in terms of total Medicaid payments in Wisconsin during 2024.
From 2019 through 2024, Medicaid payments tied to these services in Milwaukee grew by $1,507,945—an increase of 1648.8%. Growth rates accelerated at certain points, with notable year-over-year spikes occurring in 2021 and 2022.
Spending for these services across Milwaukee was distributed throughout the city, though a significant concentration occurred in a few ZIP codes. In 2024, the highest Medicaid payments linked to this category came from ZIP code 53215 with $954,461, followed by 53221 with $245,559, and 53224 at $170,658. Collectively, these 3 ZIP codes made up 85.7% of the Medicaid payments for this category in Milwaukee during the year.
Most Medicaid payments for administrative, miscellaneous and investigational services primarily reflected a small number of specific billing codes.
Between 2024 and 2023, Medicaid payments for this category in Milwaukee increased by 241.7%, compared with a 0.4% change across all Medicaid claim categories in the city for the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023. This accounted for around 18% of the nation’s total health expenditures, a substantial increase from roughly $613.5 billion in 2019, prior to the COVID-19 pandemic.
This jump marks approximately 40% growth in only a few years, fueled by higher enrollment and increased utilization during and after the pandemic.
Recent federal budget actions during the Trump administration have included major proposals to cut federal Medicaid funding and reshape the program. For instance, the “One Big Beautiful Bill Act,” signed into law in 2025, is expected to reduce federal Medicaid spending by more than $1 trillion over ten years. It introduces policies such as work requirements and greater cost-sharing, which could affect coverage and funding for some recipients. These policy shifts are likely to increase state funding responsibilities and further slow federal Medicaid growth, even as the program remains a central part of American health coverage.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $91,458 | -18.4% |
| 2021 | $191,985 | 109.9% |
| 2022 | $362,547 | 88.8% |
| 2023 | $468,017 | 29.1% |
| 2024 | $1,599,404 | 241.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $101,764,435 | 26.9% |
| 2 | National Codes Established for State Medicaid Agencies | $90,019,610 | 23.8% |
| 3 | Alcohol and Drug Abuse Treatment | $47,761,327 | 12.6% |
| 4 | Medicine Services and Procedures | $44,988,519 | 11.9% |
| 5 | Pathology and Laboratory Procedures | $22,803,025 | 6% |
| 6 | Radiology Procedures | $15,209,681 | 4% |
| 7 | Ambulance and Other Transport Services and Supplies | $13,998,065 | 3.7% |
| 8 | Temporary National Codes (Non-Medicare) | $13,536,240 | 3.6% |
| 9 | Surgery | $10,668,773 | 2.8% |
| 10 | Dental Services | $4,228,369 | 1.1% |
| 11 | Drugs Administered Other than Oral Method | $3,933,943 | 1% |
| 12 | Procedures / Professional Services | $2,339,907 | 0.6% |
| 13 | Administrative, Miscellaneous and Investigational | $1,599,404 | 0.4% |
| 14 | Chemotherapy Drugs | $1,552,956 | 0.4% |
| 15 | Pathology and Laboratory Services | $1,292,483 | 0.3% |
| 16 | Medical And Surgical Supplies | $1,233,341 | 0.3% |
| 17 | Temporary Codes | $610,150 | 0.2% |
| 18 | Anesthesia | $305,218 | 0.1% |
| 19 | Durable Medical Equipment | $269,219 | 0.1% |
| 20 | Orthotic Procedures and services | $243,203 | 0.1% |
| 21 | Vision Services | $168,676 | <0.1% |
| 22 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $112,080 | <0.1% |
| 23 | Outpatient PPS | $98,531 | <0.1% |
| 24 | Enteral and Parenteral Therapy | $91,577 | <0.1% |
| 25 | Hearing Services | $27,931 | <0.1% |
| 26 | Coronavirus Diagnostic Panel | $192 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| A9150 | Misc/exper non-prescript dru | $1,361,083 | 44 |
| A9999 | Dme supply or accessory, nos | $149,875 | 12 |
| A9502 | Tc99m tetrofosmin | $78,495 | 34 |
| A9609 | F18 fdg, 15 millicuries | $9,229 | 6 |
| A9552 | F18 fdg | $518 | 22 |
| A9585 | Gadobutrol injection | $161 | 24 |
| A9270 | Non-covered item or service | $40 | 51 |
| A9500 | Tc99m sestamibi | $0 | 17 |
| A9503 | Tc99m medronate | $0 | 5 |
| A9540 | Tc99m maa | $0 | 7 |
| A9555 | Rb82 rubidium | $0 | 7 |
| A9567 | Technetium tc-99m aerosol | $0 | 5 |
| A9575 | Inj gadoterate meglumi 0.1ml | $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.
