Grampian Medicaid payments for evaluation and management services increase 23% in 2024

According to the U.S. Department of Health and Human Services Medicaid Provider Spending database, Medicaid providers in Grampian submitted $8,581 in bills for services grouped under the Evaluation and Management category during 2024. This represents a 23% increase from 2023, when $6,977 was billed for the same services.

Medicaid is administered at the state level with joint funding from federal and state governments, as explained by the Commonwealth Fund. The program insures individuals and families with low incomes, older adults, children, and people with disabilities, and forms a key component of the U.S. health system.

Because taxpayer dollars fund Medicaid, shifts in local billing patterns reflect how public resources are allocated in health care for a community.

The “Evaluation and Management” category encompasses a range of Medicaid-billed services classified by type of patient care, based on standard HCPCS and CPT code groupings. For this study, each billing code was mapped to a single service category using established code prefixes and numeric ranges, enabling consistent analysis and maintaining accurate service rankings over time.

While Medicaid spending rose across several service groups, Evaluation and Management ranked as the top category in Grampian for total Medicaid payments in 2024.

Statewide in Pennsylvania, Evaluation and Management placed fourth by total Medicaid reimbursement for the year.

Over the five years preceding 2024, Medicaid payments for Evaluation and Management services in Grampian amounted to $8,581, showing 0% growth overall. Growth accelerated periodically during these years, with significant year-over-year increases in 2021 and 2023.

Within Grampian, spending for Evaluation and Management services was not evenly distributed; payments mostly accrued to a few ZIP codes. In 2024, ZIP code 16838 represented the entirety of such payments at $8,581, so the top ZIP code accounted for 100% of Evaluation and Management Medicaid spending in the city that year.

A limited range of individual billing codes made up most Medicaid payments in the Evaluation and Management category.

To compare, Medicaid payments tied to Evaluation and Management in Grampian grew 23% from 2023 to 2024, mirroring a 23% rise for all Medicaid claim categories citywide during the same timeframe.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending combined reached about $871.7 billion in fiscal year 2023—roughly 18% of total national health expenditures—and rose sharply from close to $613.5 billion in 2019, prior to the COVID-19 pandemic.

This jump amounts to nearly 40% growth in just a few years, driven mainly by more enrollees and increased use of services during and after the pandemic.

Recent federal budget measures under the Trump administration have included major proposals to trim federal Medicaid funding and change its structure. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid spending by over $1 trillion in the next decade, while policies like work requirements and higher cost-sharing may reduce both coverage and funding for certain recipients. These policy shifts are projected to increase state responsibility for costs and limit federal Medicaid growth, though the program still serves tens of millions nationwide.

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.