Maine’s Medicaid payments for services in the Surgery category reached $12,501,871 in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This represents a 12.7% rise compared with 2023, when claims totaled $11,094,936.
Medicaid is a public health insurance program overseen by the states and covered through combined federal and state government funding. It provides coverage to low-income people and families, as well as seniors, children, and individuals with disabilities, making it one of the largest components of the U.S. health system.
Since Medicaid is funded by taxpayers, shifts in local billing levels reveal how public health care money is distributed at the community level.
The “Surgery” category comprises a range of Medicaid-billed services identified by the type of care delivered and based on standardized HCPCS and CPT code groupings. For this report, each billing code was matched to one service category using uniform code prefixes and number ranges, grouping related services for analysis while avoiding duplicate counts and maintaining accurate long-term rankings.
When applicable, categories may include several types of core services. In such instances, the category covers interconnected forms of care commonly billed together under Medicaid, including office visits, diagnostic testing and therapeutic procedures.
In the five years preceding 2024, Medicaid payments for the Surgery category in Maine grew by $6,030,447, or 93.2%. Certain periods saw faster growth, with significant annual increases noted in 2021 and 2023.
Although spending on Surgery category services occurred across Maine, payments were centered in a few ZIP codes. ZIP Code 04102 saw the largest amount at $4,606,459 (36.8% of total), followed by ZIP Code 04401 at $1,888,539 (15.1%), and ZIP Code 04240 at $1,621,778 (13%) in 2024.
Together, these top three ZIP codes represented 64.9% of all Medicaid Surgery category spending in Maine for the year.
To compare, Medicaid payments for all categories statewide rose by 1.3% from 2023 to 2024.
Though Medicaid spending climbed across numerous service categories, the Surgery group ranked among the state’s nine highest categories by total payments during 2024.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid expenditures reached approximately $871.7 billion in fiscal 2023, making up about 18% of all U.S. health spending, rising substantially from around $613.5 billion in 2019, before the COVID-19 pandemic.
This roughly 40% increase over several years has been primarily driven by enrollment growth and higher use during and following the pandemic.
Recent federal budget bills signed during the Trump administration have featured major proposals to scale back federal Medicaid spending and reshape the program. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid funding by over $1 trillion in the next decade and includes measures like work requirements and greater cost-sharing that may decrease coverage and funding for some participants. These changes are likely to place more financial responsibility on states and slow federal Medicaid expansion, while the program continues to serve millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2024 | $12,501,871 | 12.7% |
| 2023 | $11,094,936 | 13.1% |
| 2022 | $9,806,733 | 6.9% |
| 2021 | $9,169,604 | 41.7% |
| 2020 | $6,471,424 | -10.9% |
| 2019 | $7,264,053 | 38.7% |
| 2018 | $5,237,782 | N/A |
| ZIP Code | Medicaid Payments | % of State Total |
|---|---|---|
| 04102 | $4,606,459 | 36.8% |
| 04401 | $1,888,539 | 15.1% |
| 04240 | $1,621,778 | 13% |
| 04330 | $1,162,041 | 9.3% |
| 04769 | $902,243 | 7.2% |
| 04005 | $458,748 | 3.7% |
| 04101 | $420,357 | 3.4% |
| 04011 | $383,809 | 3.1% |
| 04901 | $307,127 | 2.5% |
| 04856 | $188,024 | 1.5% |
| 04605 | $180,259 | 1.4% |
| 04096 | $48,539 | 0.4% |
| 04092 | $40,839 | 0.3% |
| 04938 | $37,790 | 0.3% |
| 04074 | $36,397 | 0.3% |
| 04062 | $26,503 | 0.2% |
| 04743 | $21,648 | 0.2% |
| 04736 | $19,679 | 0.2% |
| 04072 | $18,304 | 0.1% |
| 04654 | $17,287 | 0.1% |
| 04441 | $15,077 | 0.1% |
| 04276 | $13,306 | 0.1% |
| 04967 | $11,996 | 0.1% |
| 04268 | $8,260 | 0.1% |
| 04543 | $7,975 | 0.1% |
| 03909 | $6,986 | 0.1% |
| 04210 | $6,128 | <0.1% |
| 04730 | $5,324 | <0.1% |
| 04426 | $4,885 | <0.1% |
| 04976 | $4,768 | <0.1% |
| 04915 | $4,534 | <0.1% |
| 04104 | $3,232 | <0.1% |
| 04930 | $2,368 | <0.1% |
| 04236 | $2,357 | <0.1% |
| 04009 | $2,149 | <0.1% |
| 04254 | $1,364 | <0.1% |
| 04765 | $1,207 | <0.1% |
| 04462 | $1,140 | <0.1% |
| 04619 | $1,039 | <0.1% |
| 04649 | $1,036 | <0.1% |
| 04658 | $1,019 | <0.1% |
| 04652 | $953 | <0.1% |
| 04614 | $777 | <0.1% |
| 04043 | $727 | <0.1% |
| 03904 | $665 | <0.1% |
| 04572 | $646 | <0.1% |
| 04282 | $582 | <0.1% |
| 04457 | $549 | <0.1% |
| 04609 | $468 | <0.1% |
| 04414 | $345 | <0.1% |
| 04631 | $324 | <0.1% |
| 04630 | $320 | <0.1% |
| 04921 | $307 | <0.1% |
| 04643 | $252 | <0.1% |
| 04983 | $246 | <0.1% |
| 04917 | $242 | <0.1% |
| 04981 | $199 | <0.1% |
| 04963 | $195 | <0.1% |
| 04357 | $188 | <0.1% |
| 04259 | $183 | <0.1% |
| 04103 | $165 | <0.1% |
| 04953 | $151 | <0.1% |
| 04468 | $129 | <0.1% |
| 04578 | $112 | <0.1% |
| 04950 | $94 | <0.1% |
| 04667 | $93 | <0.1% |
| 04758 | $64 | <0.1% |
| 04416 | $55 | <0.1% |
| 04863 | $54 | <0.1% |
| 04064 | $52 | <0.1% |
| 04106 | $41 | <0.1% |
| 04756 | $32 | <0.1% |
| 04030 | $29 | <0.1% |
| 04341 | $28 | <0.1% |
| 04463 | $23 | <0.1% |
| 04910 | $22 | <0.1% |
| 04732 | $21 | <0.1% |
| 04920 | $11 | <0.1% |
| 04217 | $5 | <0.1% |
Information in this article comes from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data is available here.