According to the U.S. Department of Health and Human Services Medicaid Provider Spending database, Medicaid providers in Gaithersburg posted $78,478,000 in claims for Pathology and Laboratory Procedures in 2024. This represents a 21.8% rise from 2023, when $64,417,640 was billed for this category.
Medicaid, a joint federal and state public health insurance program, is supported by both levels of government. It serves people with low incomes, children, seniors, and individuals with disabilities, making it one of the nation’s main health coverage sources.
Local trends in Medicaid billing reflect how taxpayer-funded health care resources are distributed within communities.
The Pathology and Laboratory Procedures category covers a set of Medicaid-billed services detailed by care type, assigned by standard HCPCS and CPT codes. Analysts grouped billings under single service categories using code prefixes and ranges, which prevents duplicate counts and maintains consistent rankings over time.
Of all Medicaid service categories in Gaithersburg, Pathology and Laboratory Procedures ranked first by payment total in 2024.
Statewide in Maryland, Pathology and Laboratory Procedures placed sixth by total Medicaid payments that same year.
Between 2020 and 2024, Gaithersburg’s total Medicaid payments for Pathology and Laboratory Procedures rose by $72,215,557, or 1153.2%. Growth accelerated in key years, especially during 2021 and 2022, where significant increases occurred.
Although claims related to Pathology and Laboratory Procedures were submitted throughout Gaithersburg, most Medicaid dollars were concentrated in a small group of ZIP codes. In 2024, ZIP code 20877 accounted for $78,342,205, ZIP code 20878 for $92,741, and ZIP code 20879 for $43,053 in Medicaid payments within the category. Collectively, these 3 ZIP codes made up all (100%) payments for Pathology and Laboratory Procedures in Gaithersburg that year.
Most of the payments in this service group were claimed for a narrow range of billing codes.
In comparison, Gaithersburg’s Pathology and Laboratory Procedures Medicaid payments jumped by 21.8% from 2023 to 2024, while total claims across all categories in the city rose by 13.4% during that timeframe.
According to the Centers for Medicare & Medicaid Services, combined spending on Medicaid at federal and state levels reached about $871.7 billion during the 2023 fiscal year—about 18% of overall national health expenditures—up from $613.5 billion in 2019, just before the COVID-19 pandemic.
This marks a roughly 40% increase in just a few years, primarily driven by higher enrollment and increased utilization during and after the pandemic.
Recent federal budget acts under the Trump administration included proposals that restrict federal Medicaid spending and alter its structure. The “One Big Beautiful Bill Act,” enacted in 2025, is on track to reduce federal Medicaid spending by more than $1 trillion over 10 years and include policies such as work requirements and increased cost-sharing for beneficiaries, potentially lowering coverage and funding for many. States may bear greater program costs amid these adjustments, with limits projected on future federal Medicaid growth, even as program service levels remain substantial.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $6,262,443 | -3.8% |
| 2021 | $17,235,183 | 175.2% |
| 2022 | $37,712,730 | 118.8% |
| 2023 | $64,417,639 | 70.8% |
| 2024 | $78,478,000 | 21.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Pathology and Laboratory Procedures | $78,478,000 | 58.5% |
| 2 | Temporary National Codes (Non-Medicare) | $25,843,314 | 19.3% |
| 3 | Medicine Services and Procedures | $12,389,106 | 9.2% |
| 4 | Evaluation and Management | $6,477,272 | 4.8% |
| 5 | Alcohol and Drug Abuse Treatment | $4,957,613 | 3.7% |
| 6 | National Codes Established for State Medicaid Agencies | $1,830,402 | 1.4% |
| 7 | Ambulance and Other Transport Services and Supplies | $1,718,656 | 1.3% |
| 8 | Dental Services | $1,228,702 | 0.9% |
| 9 | Medical And Surgical Supplies | $713,202 | 0.5% |
| 10 | Surgery | $178,664 | 0.1% |
| 11 | Enteral and Parenteral Therapy | $128,468 | 0.1% |
| 12 | Vision Services | $114,748 | 0.1% |
| 13 | Procedures / Professional Services | $77,641 | 0.1% |
| 14 | Radiology Procedures | $34,697 | <0.1% |
| 15 | Drugs Administered Other than Oral Method | $18,336 | <0.1% |
| 16 | Administrative, Miscellaneous and Investigational | $5,255 | <0.1% |
| 17 | Temporary Codes | $1,139 | <0.1% |
| 18 | Durable Medical Equipment | $395 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 81416 | Exome sequence analysis | $41,711,279 | 25 |
| 81415 | Exome sequence analysis | $22,716,177 | 26 |
| 81229 | Cytog alys chrml abnr snpcgh | $4,379,806 | 20 |
| 81460 | Whole mitochondrial genome | $1,686,402 | 22 |
| 81479 | Unlisted molecular pathology | $1,635,858 | 23 |
| 81425 | Genome sequence analysis | $1,454,769 | 15 |
| 81465 | Whole mitochondrial genome | $1,233,019 | 22 |
| 81426 | Genome sequence analysis | $1,044,554 | 15 |
| 81408 | Mopath procedure level 9 | $551,274 | 21 |
| 81406 | Mopath procedure level 7 | $189,991 | 22 |
| 81407 | Mopath procedure level 8 | $188,518 | 20 |
| 81405 | Mopath procedure level 6 | $179,024 | 22 |
| 81243 | Fmr1 gen aly detc abnl allel | $155,871 | 20 |
| 81404 | Mopath procedure level 5 | $155,155 | 22 |
| 81470 | X-linked intellectual dblt | $152,178 | 13 |
| 81471 | X-linked intellectual dblt | $139,668 | 13 |
| 81430 | Hearing loss sequence analys | $139,481 | 11 |
| 81185 | Cacna1a gene full gene seq | $121,079 | 12 |
| 81411 | Aortic dysfunction/dilation | $74,949 | 8 |
| 81302 | Mecp2 gene full seq | $72,794 | 12 |
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.
