Athens Medicaid providers billed $1,933 for evaluation and management services in 2024, a 48% uptick

Medicaid providers in Athens submitted $1,933 in claims for Evaluation and Management services during 2024, based on the U.S. Department of Health and Human Services Medicaid Provider Spending database. That figure represents a 47.6% increase from 2023, when claims totaled $1,310 for the same category of services.

Medicaid, a public health insurance initiative funded jointly by state and federal governments, provides coverage for low-income families and individuals, seniors, children, and people living with disabilities. With this broad base, Medicaid stands as a cornerstone within the U.S. health care system.

Variations in how local providers bill Medicaid reflect shifts in how taxpayer-funded health care dollars are spent in a given community.

The “Evaluation and Management” label covers a set of Medicaid services, grouped by type of care according to standardized HCPCS and CPT billing codes. Each code in this analysis was assigned to one service category using code prefix and numeric groupings to ensure grouped comparisons, attribute related payments correctly, and prevent double-counting over time.

Though several service categories saw higher Medicaid expenditures, Evaluation and Management placed second in Athens by overall Medicaid payments for 2024.

Statewide, the Evaluation and Management category also ranked second for Medicaid disbursement in West Virginia in 2024.

From 2019 through 2024, Athens’ Medicaid claims for Evaluation and Management rose by $1,551—a 406% surge. Payments accelerated markedly at certain points, especially in 2022 and 2023, with sharp year-over-year increases.

While Evaluation and Management spending was distributed throughout Athens, the majority of payments in 2024 were concentrated within a few ZIP codes; notably, $1,932 of the total was linked to the 24712 ZIP code. This single ZIP code represented 100% of local Medicaid funds for Evaluation and Management during the period.

Payments in the category further centered on a select set of billing codes assigned to Evaluation and Management.

Compared to a citywide increase of 14.3% across all Medicaid service categories from 2023 to 2024, Athens’ Evaluation and Management category climbed by 47.6% in the same timeframe.

Centers for Medicare & Medicaid Services report combined federal and state Medicaid spending amounted to roughly $871.7 billion in fiscal year 2023—about 18% of total national health expenditures—up from $613.5 billion in 2019, before the COVID-19 pandemic.

This increase represents nearly 40% growth over several years, largely attributable to broader enrollment and greater utilization throughout and beyond the pandemic.

Federal budget measures under the Trump administration included substantial reforms targeted at federal Medicaid funding and design. The “One Big Beautiful Bill Act”, enacted in 2025, is estimated to slash more than $1 trillion from federal Medicaid spending over 10 years and add requirements—such as work rules and more beneficiary cost-sharing—that could reduce available coverage and financing for some participants. These policy adjustments are likely to transfer greater expense to states and place constraints on federal Medicaid assistance, even as enrollment remains high.

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.