Medicaid providers in Pisgah billed a total of $321 for Evaluation and Management services in 2024, with data drawn from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This figure reflects a 130.9% rise compared to 2023, when $139 in claims were submitted for the same category of services.
Medicaid is a public health insurance initiative managed by individual states and funded in partnership by federal and state governments. It provides coverage to low-income people and families, seniors, children, and those with disabilities, and remains one of the nation’s largest health care programs.
As Medicaid is funded by taxpayers, fluctuations in local billing reveal how health care dollars are distributed within communities.
The “Evaluation and Management” group refers to a set of Medicaid-billed services defined by type of care, based on standardized HCPCS and CPT coding. Each billing code was grouped into a single service category using uniform prefixes and numeric ranges to compare related services, avoid duplicate counts, and maintain accurate rankings over time.
Although multiple service categories saw higher Medicaid spending, Evaluation and Management ranked third among all Medicaid payments in Pisgah for 2024.
Statewide in Alabama, Evaluation and Management placed second by total Medicaid payments in 2024.
From 2019 through 2024, Medicaid payments for the Evaluation and Management category in Pisgah rose by $3,163, a growth rate of 90.8%. Spending increased most rapidly during some intervals, including notable year-over-year jumps in 2022 and 2023.
Services in the Evaluation and Management group were billed throughout Pisgah, but payments were most concentrated in certain ZIP codes. In 2024, ZIP code 35765 had the highest Medicaid payments linked to this group, totaling $321, with the top 1 ZIP codes accounting for all Medicaid payments in the category within Pisgah for the year.
Medicaid payments in this category were also concentrated among a select set of individual billing codes.
In comparison, the 130.9% year-over-year rise in Medicaid payments for Evaluation and Management services in Pisgah between 2024 and 2023 exceeded the 44.2% increase seen across all Medicaid claim categories in the city during the same timeframe.
Centers for Medicare & Medicaid Services data show that combined federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023, accounting for approximately 18% of total U.S. health expenditures, sharply up from around $613.5 billion in 2019 before the COVID-19 pandemic.
This represents growth of about 40% over several years, driven mainly by increased enrollment and higher utilization during and following the pandemic period.
Recent federal budget laws under the Trump administration introduced significant proposals aimed at reducing federal Medicaid funding and changing the structure of the program. For instance, the “One Big Beautiful Bill Act,” signed into law in 2025, is projected to cut more than $1 trillion from federal Medicaid spending in the next decade and institutes work requirements and higher cost-sharing that may reduce coverage and federal funds for certain participants. These policy shifts are likely to increase the financial burden on states and could limit further growth in federal Medicaid support as the program continues to cover tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $3,484 | -15.3% |
| 2021 | $128 | -96.3% |
| 2022 | $129 | 0.6% |
| 2023 | $138 | 7% |
| 2024 | $321 | 131.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $154,363 | 99.3% |
| 2 | Pathology and Laboratory Procedures | $506 | 0.3% |
| 3 | Evaluation and Management | $321 | 0.2% |
| 4 | Medicine Services and Procedures | $309 | 0.2% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99214 | Office o/p est mod 30 min | $263 | 9 |
| 99213 | Office o/p est low 20 min | $57 | 28 |
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.
