Tualatin Medicaid providers billed $201,338 for surgery-related services in 2024, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 12.7% gain over 2023, when $178,721 in claims for these services was recorded.
Medicaid is a public insurance program overseen by states and jointly funded by federal and state governments. It provides coverage for low-income individuals and families, seniors, children, and people with disabilities, making it a vital component of the U.S. health care system.
Since Medicaid payments are sourced from taxpayers, fluctuations in local billing illustrate how public health care funds are distributed within a community.
The “Surgery” service category covers a range of Medicaid-billed procedures, defined by service type and grouped through standardized HCPCS and CPT codes. Codes were assigned to a single service category using consistent prefixes and numeric ranges in this analysis, organizing related services together, preventing double counting, and maintaining ranking accuracy over time.
Even as Medicaid spending rose across several service groups, Surgery ranked sixth by total Medicaid payments in Tualatin in 2024.
Across Oregon, Surgery placed 13th among all service categories by Medicaid payments in 2024.
From five years before 2024, Medicaid payments for Surgery services in Tualatin rose by $72,638, or 56.4%. This growth accelerated at certain points, with sizable annual increases seen in 2021 and 2023.
Though Surgery-related Medicaid spending was distributed throughout Tualatin, it was concentrated in only a few ZIP codes. In 2024, ZIP code 97062 accounted for $201,337 in Medicaid payments tied to Surgery—representing 100% of the city’s total for this category that year.
Payments within the Surgery category were also focused on a small set of individual billing codes.
To compare, Medicaid payments for Surgery services in Tualatin climbed 12.7% between 2024 and 2023, while total Medicaid claims citywide grew 10.9% during the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled about $871.7 billion in fiscal 2023, or around 18% of the nation’s total health care expenditures. This figure was up significantly from $613.5 billion in 2019, before the COVID-19 pandemic.
This increase reflects roughly 40% growth in just a few years, driven largely by expanded enrollment and increased utilization during and following the pandemic.
Recent federal budget legislation signed under the Trump administration included major proposals to reduce federal Medicaid funding and change the program’s structure. The “One Big Beautiful Bill Act,” passed in 2025, is expected to result in over $1 trillion in federal funding reductions to Medicaid over the next decade and introduces policies like work requirements and higher cost-sharing. These changes could decrease funding and coverage for some recipients, shift more costs to state governments, and moderate federal Medicaid growth even as millions continue to rely on the program.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $128,700 | -5.8% |
| 2021 | $216,548 | 68.3% |
| 2022 | $156,908 | -27.5% |
| 2023 | $178,720 | 13.9% |
| 2024 | $201,337 | 12.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $2,469,591 | 51% |
| 2 | Durable Medical Equipment | $606,917 | 12.5% |
| 3 | Medicine Services and Procedures | $572,610 | 11.8% |
| 4 | Radiology Procedures | $550,110 | 11.4% |
| 5 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $309,341 | 6.4% |
| 6 | Surgery | $201,337 | 4.2% |
| 7 | Alcohol and Drug Abuse Treatment | $55,421 | 1.1% |
| 8 | Procedures / Professional Services | $34,149 | 0.7% |
| 9 | Dental Services | $28,855 | 0.6% |
| 10 | Temporary Codes | $8,259 | 0.2% |
| 11 | National Codes Established for State Medicaid Agencies | $1,770 | <0.1% |
| 12 | Medical And Surgical Supplies | $1,482 | <0.1% |
| 13 | Pathology and Laboratory Procedures | $1,104 | <0.1% |
| 14 | Anesthesia | $815 | <0.1% |
| 15 | Pathology and Laboratory Services | $56 | <0.1% |
| 16 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| 16 | Drugs Administered Other than Oral Method | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 45385 | Colonoscopy w/lesion removal | $117,864 | 10 |
| 43239 | Egd biopsy single/multiple | $57,163 | 7 |
| 66984 | Xcapsl ctrc rmvl w/o ecp | $26,131 | 5 |
| 36415 | Coll venous bld venipuncture | $178 | 6 |
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.
