Data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows that Medicaid providers in East Setauket billed $68,679 for Surgery services in 2024. This represents a 62% increase over the previous year, when claims amounted to $42,395 for these services.
Medicaid, administered by the states and funded through a partnership of federal and state governments, provides health coverage for low-income individuals, families, seniors, children, and people with disabilities, making it a significant component of the U.S. health care sector.
Because Medicaid funding comes from taxpayers, changes in local billing in East Setauket reflect shifts in how public health care funds are distributed in the community.
The Surgery category covers Medicaid-billed services defined by their care type, using standardized HCPCS and CPT code groupings. In this analysis, billing codes were assigned to distinct service categories based on established code prefixes and numeric intervals, helping to track related services and produce accurate yearly comparisons without overlap.
While multiple categories saw rising spending, Surgery ranked third among Medicaid payment categories in East Setauket during 2024.
Statewide in New York, Surgery ranked 10th for total Medicaid payments for the year.
Between 2019 and 2024, Medicaid payments for Surgery services in East Setauket increased by $64,258, or 1453.4%. There were significant annual jumps in spending, notably in 2021 and 2022.
Though Surgery payments were made in various East Setauket areas, the majority were concentrated within a small group of ZIP codes. In 2024, ZIP code 11733 made up the entire $68,679 in Surgery-related Medicaid payments, accounting for 100% of these payments in the community.
A limited set of billing codes generated most of the Medicaid spending in the Surgery category.
Comparing the growth in East Setauket, Surgery category payments rose 62% from 2023 to 2024, while overall Medicaid payment categories across the city saw a 50.4% change in the same timeframe.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled approximately $871.7 billion in fiscal year 2023, comprising roughly 18% of all national health expenditure, up from $613.5 billion in 2019 prior to the COVID-19 public health emergency.
This growth represents about a 40% increase over four years, with much of it attributed to higher enrollment and utilization during and after the pandemic.
Recent federal legislation enacted under the Trump administration introduced notable changes to Medicaid’s federal support. The “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to reduce federal Medicaid funding by more than $1 trillion over 10 years and establishes new rules like work requirements and higher cost-sharing for some program participants. These changes are likely to shift additional costs to states and place limitations on federal Medicaid support, as Medicaid continues to provide coverage for tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,421 | 71.2% |
| 2021 | $18,135 | 310.2% |
| 2022 | $34,315 | 89.2% |
| 2023 | $42,395 | 23.5% |
| 2024 | $68,679 | 62% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $456,311 | 66.7% |
| 2 | Pathology and Laboratory Procedures | $104,640 | 15.3% |
| 3 | Surgery | $68,679 | 1<0.1% |
| 4 | Medicine Services and Procedures | $27,648 | 4% |
| 5 | Procedures / Professional Services | $10,726 | 1.6% |
| 6 | National Codes Established for State Medicaid Agencies | $8,341 | 1.2% |
| 7 | Vision Services | $6,159 | 0.9% |
| 8 | Orthotic Procedures and services | $1,242 | 0.2% |
| 9 | Drugs Administered Other than Oral Method | $104 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 43239 | Egd biopsy single/multiple | $57,170 | 25 |
| 45380 | Colonoscopy and biopsy | $10,590 | 5 |
| 51798 | Us urine capacity measure | $713 | 4 |
| 36415 | Coll venous bld venipuncture | $204 | 30 |
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.
