Hart Medicaid claims for Evaluation and Management reach $5,187 in 2024, up 9%

In 2024, Hart Medicaid providers submitted $5,187 in claims for services under the Evaluation and Management category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database indicate. The total represents a 9% rise over 2023, when total claims for these services amounted to $4,758.

Medicaid operates as a public insurance program managed by states, with funding provided jointly through federal and state sources. It offers coverage for low-income residents, seniors, children, and individuals living with disabilities, and comprises a significant portion of the U.S. health care landscape.

Since Medicaid funding is drawn from tax revenues, trends in local claim amounts highlight how public health care funds are spent at the community level.

The “Evaluation and Management” group consists of a set of Medicaid service codes based on specific care types, categorized using standardized HCPCS and CPT code ranges. Each billing code in this data was assigned to a single group through consistent numerical criteria, helping to analyze related services together without double counting and to maintain ordering accuracy year over year.

Spending across various Medicaid service groups climbed, with Evaluation and Management placing third by total payments in Hart for 2024.

For Michigan as a whole, Evaluation and Management also ranked third among Medicaid payment categories in 2024.

In the five years leading to 2024, Medicaid payments for Hart’s Evaluation and Management category jumped by $7,969, or 60.6%. Some periods saw sharper growth, particularly in 2021 and 2020, where annual increases stood out.

Payments for Evaluation and Management services were distributed throughout Hart, but were focused in a small set of ZIP codes. For 2024, the 49420 ZIP code covered $5,187 in such Medicaid claims, and was responsible for 100% of Hart’s total Medicaid payments in this service category during the year.

Within this category, just a handful of billing codes represented most Medicaid claims.

When compared to all other Medicaid claim categories in Hart, payments for Evaluation and Management services climbed by 9% between 2024 and 2023, while citywide Medicaid claims for all categories shifted by 18.5% over the same period.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached around $871.7 billion for fiscal year 2023, making up about 18% of national health spending. This is a significant increase from roughly $613.5 billion in 2019, prior to the COVID-19 pandemic.

This change marks an increase of about 40% over several years, largely attributable to expanded Medicaid rolls and increased health service usage during and following the pandemic.

Federal budget measures during the Trump administration featured major proposals to reduce federal support for Medicaid and alter the program. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to decrease federal Medicaid spending by more than $1 trillion over a decade and add features such as work requirements and higher cost-sharing, potentially affecting both funding and coverage. As a result, a greater share of costs could shift to states, even as the program continues to support tens of millions of Americans.

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.