In 2024, Medicaid providers in Middletown billed $69,945 for services under the Evaluation and Management category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 10.6% increase over 2023, when $63,260 in claims for the category were submitted.
Medicaid is a public health insurance program managed by the states and financed by both federal and state governments. It serves low-income families and individuals, seniors, children, and people with disabilities, making it a significant component of the U.S. health care system.
Since taxpayer dollars fund Medicaid payments, shifts in local billing reflect how community health care funds are used.
The “Evaluation and Management” category consists of Medicaid-billed services grouped by care type, using standardized HCPCS and CPT code ranges. Each code analyzed was assigned to one category for the purposes of this study to provide accurate rankings and trends, while eliminating double counting.
Evaluation and Management was the second highest service category for Medicaid payments in Middletown in 2024, following increases in other service categories as well.
The Evaluation and Management group also ranked No. 2 statewide for Medicaid payments in California in 2024.
From 2019 through 2024, Medicaid funds tied to Evaluation and Management in Middletown increased by $35,207, a 101.4% jump. The pace of spending growth was especially strong in 2020 and 2021, with notable annual increases.
While Evaluation and Management spending was distributed throughout Middletown, it was mostly concentrated in select ZIP codes. In 2024, ZIP code 95461 accounted for $69,945, with the top ZIP code making up 100% of category-related Medicaid payments for the city that year.
Spending under the Evaluation and Management category was largely focused on a small set of Medicaid billing codes.
Between 2024 and 2023, Evaluation and Management Medicaid payments in Middletown rose 10.6%, while all categories collectively saw a 25.1% increase in the city during the same period.
According to the Centers for Medicare & Medicaid Services, state and federal Medicaid spending combined reached about $871.7 billion in fiscal year 2023. This represented roughly 18% of all national health expenditures and was up sharply from about $613.5 billion in 2019, prior to the COVID-19 pandemic.
This reflects nearly 40% growth in just a few years, driven in part by increased enrollment and higher demand for health care services during and after the pandemic.
Recent federal budget measures signed during the Trump administration have introduced major proposals to reduce Medicaid funding and adjust the program’s structure. As an example, the “One Big Beautiful Bill Act,” passed in 2025, is slated to cut over $1 trillion from federal Medicaid spending in the next 10 years, while implementing changes like work requirements and higher cost-sharing. These measures could lower funding and coverage for some recipients, shifting more fiscal responsibility to states as federal support becomes more limited, even as Medicaid continues to provide services for millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $34,737 | 944.1% |
| 2021 | $70,270 | 102.3% |
| 2022 | $76,164 | 8.4% |
| 2023 | $63,260 | -16.9% |
| 2024 | $69,945 | 10.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $309,599 | 81.4% |
| 2 | Evaluation and Management | $69,945 | 18.4% |
| 3 | Medicine Services and Procedures | $551 | 0.1% |
| 4 | Pathology and Laboratory Procedures | $381 | 0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $25,415 | 22 |
| 99214 | Office o/p est mod 30 min | $21,520 | 21 |
| 99212 | Office o/p est sf 10 min | $8,562 | 11 |
| 99204 | Office o/p new mod 45 min | $5,128 | 3 |
| 99203 | Office o/p new low 30 min | $5,005 | 4 |
| 99392 | Prev visit est age 1-4 | $2,697 | 3 |
| 99391 | Per pm reeval est pat infant | $834 | 1 |
| 99202 | Office o/p new sf 15 min | $780 | 1 |
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.
