In 2024, Elkin Medicaid providers billed $3,608,863 for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This reflected a 7.8% increase from 2023, when claims for the same services reached $3,348,984.
Medicaid is a public insurance program operated by individual states and funded through a partnership of federal and state governments. It provides coverage for low-income families and individuals, seniors, children, and those with disabilities, making it a significant component of the nation’s health care system.
Because Medicaid’s funding comes from taxpayers, shifts in local billing amounts indicate how public health funding is distributed within a community.
The Evaluation and Management category groups Medicaid-billed services defined by care type and based on HCPCS and CPT code groupings. For the purposes of analysis, each billing code was classified into a single category by using consistent code prefixes and numerical ranges, which helps ensure related services are studied together while preventing double counting and maintaining accurate rankings over time.
Even as Medicaid spending rose in several categories, Evaluation and Management ranked as the second-largest by total Medicaid payments in Elkin for 2024.
Statewide, Evaluation and Management also placed second among all payment categories in North Carolina for 2024.
Between 2019 and 2024, Medicaid payments for the Evaluation and Management category in Elkin grew by $1,520,336, or 72.8%. Certain years, including 2021 and 2022, saw especially rapid year-over-year increases.
Although Evaluation and Management spending was distributed citywide, the majority of payments were concentrated in a few ZIP codes. In 2024, ZIP code 28621 accounted for all $3,608,863 in Medicaid payments for this category, making up 100% of related spending across Elkin that year.
Medicaid payments within Evaluation and Management were also concentrated among relatively few individual billing codes.
For additional perspective, between 2024 and 2023 Elkin’s Evaluation and Management Medicaid payments increased by 7.8%. By contrast, all Medicaid claim categories together saw a 10.5% change in the city during the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures reached approximately $871.7 billion in fiscal year 2023, representing nearly 18% of overall national health spending—up significantly from around $613.5 billion in 2019 before the COVID-19 pandemic.
This growth amounts to roughly a 40% increase over several years, primarily driven by expanded enrollment and higher utilization through and after the pandemic.
Recent federal budgets under the Trump administration have included major proposals to reduce federal Medicaid funding and revise the program. The “One Big Beautiful Bill Act,” signed in 2025, is expected to decrease federal Medicaid funding by more than $1 trillion over the next decade and establishes new measures like work requirements and increased beneficiary cost-sharing that may limit coverage and funding for some individuals. These policy changes are likely to shift additional costs to states and further constrain growth in federal Medicaid support, even as the program continues to cover tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $2,088,526 | -35.5% |
| 2021 | $2,718,223 | 30.2% |
| 2022 | $3,181,117 | 17% |
| 2023 | $3,348,983 | 5.3% |
| 2024 | $3,608,863 | 7.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Medical And Surgical Supplies | $4,667,210 | 44.3% |
| 2 | Evaluation and Management | $3,608,863 | 34.2% |
| 3 | National Codes Established for State Medicaid Agencies | $980,916 | 9.3% |
| 4 | Medicine Services and Procedures | $784,138 | 7.4% |
| 5 | Pathology and Laboratory Procedures | $225,834 | 2.1% |
| 6 | Radiology Procedures | $108,805 | 1% |
| 7 | Procedures / Professional Services | $55,381 | 0.5% |
| 8 | Surgery | $47,993 | 0.5% |
| 9 | Drugs Administered Other than Oral Method | $30,344 | 0.3% |
| 10 | Temporary National Codes (Non-Medicare) | $15,277 | 0.1% |
| 11 | Dental Services | $14,361 | 0.1% |
| 12 | Durable Medical Equipment | $3,872 | <0.1% |
| 13 | Temporary Codes | $1,945 | <0.1% |
| 14 | Administrative, Miscellaneous and Investigational | $720 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99214 | Office o/p est mod 30 min | $974,121 | 625 |
| 99284 | Emergency dept visit mod mdm | $796,539 | 215 |
| 99199 | Unlisted special svc px/rprt | $568,213 | 96 |
| 99213 | Office o/p est low 20 min | $468,157 | 390 |
| 99283 | Emergency dept visit low mdm | $296,887 | 103 |
| 99285 | Emergency dept visit hi mdm | $213,545 | 81 |
| 99204 | Office o/p new mod 45 min | $70,139 | 46 |
| 99392 | Prev visit est age 1-4 | $49,629 | 26 |
| 99393 | Prev visit est age 5-11 | $47,931 | 24 |
| 99309 | Sbsq nf care moderate mdm 30 | $35,178 | 12 |
| 99391 | Per pm reeval est pat infant | $32,316 | 19 |
| 99394 | Prev visit est age 12-17 | $21,189 | 9 |
| 99308 | Sbsq nf care low mdm 20 | $12,218 | 9 |
| 99215 | Office o/p est hi 40 min | $5,776 | 3 |
| 99212 | Office o/p est sf 10 min | $4,868 | 4 |
| 99238 | Hosp ip/obs dschrg mgmt 30/< | $3,231 | 6 |
| 99203 | Office o/p new low 30 min | $2,921 | 5 |
| 99222 | 1st hosp ip/obs moderate 55 | $1,806 | 4 |
| 99205 | Office o/p new hi 60 min | $1,232 | 1 |
| 99173 | Visual acuity screen | $1,212 | 45 |
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.
