Evaluation and Management Medicaid payments in Madison rise 11% to $440,353 in 2024

In 2024, Medicaid providers in Madison billed $440,353 for Evaluation and Management services, up 10.9% from $397,204 the previous year, according to U.S. Department of Health and Human Services Medicaid Provider Spending data.

Medicaid, a public health insurance program overseen by states and funded jointly by federal and state governments, serves a range of groups including low-income individuals, families, seniors, children, and people with disabilities. This makes it a major segment of the country’s health care landscape.

Since Medicaid is financed with taxpayer dollars, shifts in local billing amounts demonstrate how public health funds are distributed within a community.

The Evaluation and Management classification represents a set of Medicaid-billed services identified by the type of care using standardized HCPCS and CPT code groupings. This analysis placed each billing code into one service category by uniform prefixes and number ranges, allowing related services to be reviewed together while ensuring accurate year-over-year comparisons without duplication.

Multiple Medicaid service categories saw spending increases, but Evaluation and Management led in Madison for total Medicaid payments in 2024.

For North Carolina overall, the Evaluation and Management group ranked second in statewide Medicaid payments for the year.

Examining the five-year period ending in 2024, Madison’s Medicaid payments in the Evaluation and Management group climbed by $266,276, a gain of 153%. Growth accelerated during certain intervals, with sharp increases seen in both 2022 and 2021.

Although care in the Evaluation and Management group took place throughout the city, Medicaid dollars were concentrated in a small number of ZIP codes. In 2024, ZIP code 27025 alone recorded $440,352 in such payments, making up 100% of all local Evaluation and Management Medicaid billing.

Within this category, payments were also highly focused among a few individual billing codes.

To compare, Medicaid payments tied to Evaluation and Management services climbed by 10.9% locally between 2024 and 2023, while all Medicaid claims in Madison saw an 11.5% increase during the same time.

According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached about $871.7 billion for fiscal year 2023. This made up roughly 18% of all U.S. health expenditures and was a significant jump from $613.5 billion in 2019 before the COVID-19 pandemic.

This change marks an estimated 40% growth over a short span, driven by higher enrollment and usage during and after the pandemic.

Recent federal budgets passed during the Trump administration have introduced major plans to decrease federal Medicaid dollars and change the program’s structure. The “One Big Beautiful Bill Act,” implemented in 2025, is projected to cut more than $1 trillion in federal Medicaid spending over the next decade, setting new policies like work requirements and cost-sharing, which could limit beneficiary coverage and shift costs to states.

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.