Medicaid Evaluation and Management payments in Montgomery surge to $86,078 in 2024

Medicaid providers in Montgomery billed $86,078 for services classified within the Evaluation and Management category in 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represented a 430.3% jump from 2023, when claims for these services totaled $16,232.

A public insurance program managed by the states and funded with both federal and state resources, Medicaid covers low-income residents, children, seniors, and people with disabilities, making it a significant component of the national health care system.

Because Medicaid funds originate from taxpayers, changes in local claim levels demonstrate how public health care dollars are deployed within a community.

The “Evaluation and Management” designation groups services billed to Medicaid by type of care provided, using standardized HCPCS and CPT code assignments. For this analysis, billing codes were placed into unique service categories based on consistent code prefixes and numeric ranges, ensuring services are analyzed collectively, avoiding duplicate counts, and keeping accurate year-over-year rankings.

While Medicaid spending rose across several service types, Evaluation and Management was the city’s second-highest category by total Medicaid payments in 2024.

Statewide in Ohio, Evaluation and Management placed third among service categories by total Medicaid payments in 2024.

In the five years preceding 2024, Montgomery’s Medicaid spending for Evaluation and Management increased by $75,204, or 691.6%. Notable annual increases were observed in 2023 and 2022, with the pace of spending growth quickening at times throughout the period.

Though spending for Evaluation and Management services was distributed throughout Montgomery, payments were highly concentrated in a limited number of ZIP codes. In 2024, ZIP code 45242 accounted for all of the $86,078 in Medicaid payments under this category. The top ZIP code represented 100% of Montgomery’s Medicaid Evaluation and Management payments in 2024.

Payments in this category were also clustered among relatively few billing codes.

Compared with the 430.3% year-over-year growth for Evaluation and Management payments in Montgomery from 2023 to 2024, all Medicaid claim categories in the city saw an 11.3% increase during the same timeframe.

The Centers for Medicare & Medicaid Services reports that combined federal and state Medicaid expenditures reached approximately $871.7 billion in fiscal year 2023, which accounted for around 18% of national health expenditures—an increase from roughly $613.5 billion in 2019 before the COVID-19 pandemic.

This overall growth of about 40% over several years was largely driven by greater enrollment and care use during and following the pandemic.

Recent federal budget bills under the Trump administration have featured notable proposals to shrink federal Medicaid spending and reshape the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is set to reduce federal Medicaid funding by more than $1 trillion in the next decade. The legislation introduces policies such as work requirements and higher cost-sharing that could curtail funding and coverage for some. These shifts are expected to transfer additional costs to states and restrain federal funding growth, while Medicaid continues covering tens of millions of people.

Note: HCPCS codes are provided for reference within this category. Category totals and rankings cited here are determined using standardized service groupings instead of individual codes.

Data used in this article originate from the U.S. Department of Health and Human Services Medicaid Provider Spending database. View the original source here.