Data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows that Medicaid providers in Fredericktown received $475 for Evaluation and Management category services in 2024. This was a 1.7% rise over 2023, when such claims amounted to $467 for the same services.
Medicaid is a state-operated health insurance program financed jointly by federal and state governments. The program offers coverage for low-income individuals and families, seniors, children and those with disabilities, making it one of the most significant components of the U.S. health care system.
Since Medicaid is funded by taxpayers, changes in local billing show how community health care resources are spent.
The “Evaluation and Management” classification encompasses a group of Medicaid-covered services determined by the nature of care delivered, based on standardized HCPCS and CPT code groups. This review assigned each billing code to a corresponding service group using consistent code prefixes and number ranges to group similar services while avoiding double counting and ensuring accurate rankings over time.
Evaluation and Management was the fourth-largest service category by Medicaid payment total in Fredericktown for 2024, despite overall spending increases in several categories.
Statewide in Pennsylvania, Evaluation and Management also ranked fourth for total Medicaid payments during 2024.
In the five years leading up to 2024, Fredericktown’s Medicaid payments for Evaluation and Management services grew by $475, representing 0% overall change. Certain years saw higher spending growth, including significant increases between 2023 and 2022.
While Evaluation and Management services were billed throughout Fredericktown, payments were mostly confined to select ZIP codes. During 2024, the highest Medicaid payments for this category were located in 15333, with a total of $475. This ZIP code accounted for 100% of Fredericktown’s Evaluation and Management Medicaid payments that year.
A small number of specific billing codes within the Evaluation and Management category accounted for most Medicaid spending.
Comparatively, Medicaid payments in Fredericktown for Evaluation and Management services rose 1.7% between 2024 and 2023, whereas all Medicaid claim categories citywide grew by 9.6% over the same period.
The Centers for Medicare & Medicaid Services reports that fiscal year 2023 saw combined federal and state Medicaid spending reach approximately $871.7 billion—about 18% of total national health expenditures—rising steeply from $613.5 billion in 2019, before the COVID-19 pandemic.
This amounts to around 40% growth over just a few years, driven primarily by expanded enrollment and increased service utilization during and following the pandemic.
Recent federal budget changes under the Trump administration included major proposals to restructure and reduce federal Medicaid funding. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to trim more than $1 trillion from federal Medicaid spending over ten years and brings in requirements such as work eligibility and greater cost-sharing, potentially decreasing some beneficiaries’ funding and coverage. This legislation could leave states with a greater share of costs and slow the increase of federal Medicaid support, though the program still covers tens of millions of people.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $0 | – |
| 2021 | $0 | – |
| 2022 | $334 | – |
| 2023 | $467 | 39.7% |
| 2024 | $475 | 1.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $3,992,025 | 99.9% |
| 2 | Vision Services | $2,823 | 0.1% |
| 3 | Pathology and Laboratory Procedures | $1,556 | <0.1% |
| 4 | Evaluation and Management | $475 | <0.1% |
| 5 | Medicine Services and Procedures | $105 | <0.1% |
| 6 | Procedures / Professional Services | $19 | <0.1% |
| 7 | Surgery | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $320 | 101 |
| 99214 | Office o/p est mod 30 min | $155 | 21 |
| 99080 | Special reports or forms | $0 | 1 |
| 99173 | Visual acuity screen | $0 | 10 |
| 99202 | Office o/p new sf 15 min | $0 | 11 |
| 99203 | Office o/p new low 30 min | $0 | 10 |
| 99204 | Office o/p new mod 45 min | $0 | 2 |
| 99212 | Office o/p est sf 10 min | $0 | 12 |
| 99392 | Prev visit est age 1-4 | $0 | 5 |
| 99393 | Prev visit est age 5-11 | $0 | 6 |
| 99394 | Prev visit est age 12-17 | $0 | 7 |
| 99395 | Prev visit est age 18-39 | $0 | 11 |
| 99396 | Prev visit est age 40-64 | $0 | 12 |
| 99406 | Behav chng smoking 3-10 min | $0 | 11 |
| 99408 | Audit/dast 15-30 min | $0 | 4 |
| 99495 | Transj care mgmt mod f2f 14d | $0 | 7 |
| 99496 | Transj care mgmt high f2f 7d | $0 | 9 |
| 99499 | Unlisted e&m service | $0 | 6 |
Note: HCPCS codes are provided for reference within the category. The totals and rankings reported in this story are based on standardized groupings of services rather than on individual billing code amounts.
The information in this article was gathered from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Access the source data here.
