In Winston Salem, Medicaid providers billed $1,478,469 for Evaluation and Management services in 2024, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 5.1% uptick versus 2023, when $1,406,773 was submitted in claims for similar services.
Medicaid is a public program administered by states with funding shared by federal and state governments. It serves low-income populations, including families, seniors, children, and people with disabilities, forming a significant component of the nation’s health system.
Since Medicaid expenses are taxpayer-funded, changes in local billing levels indicate how public health resources are distributed across communities.
The “Evaluation and Management” grouping designates certain Medicaid-billed services categorized by care type, utilizing uniform HCPCS and CPT code clusters. Each code used in this analysis was placed in one service group to prevent overlapping and ensure reporting accuracy and comparability throughout the years.
Evaluation and Management ranked fourth in total Medicaid payments among service groups in Winston Salem during 2024, as Medicaid spending rose in several categories citywide.
Statewide in North Carolina, the Evaluation and Management category was second in overall payments during 2024.
Across the five years up to 2024, Medicaid payments linked to Evaluation and Management rose by $453,271, or 44.2%, in Winston Salem. Spending increases were notable in select time frames, as seen with significant annual growth in 2023 and 2022.
Citywide, Evaluation and Management spending was present in multiple ZIP codes but predominated in a few specific areas. In 2024, ZIP 27103 had $1,449,268 in payments, ZIP 27101 reached $27,625, and ZIP 27105 registered $1,574. These top 3 ZIP codes collectively contributed all Evaluation and Management Medicaid payments in the city that year.
Medicaid payments in Evaluation and Management were also heavily concentrated within a small segment of unique billing codes.
For reference, Evaluation and Management Medicaid payments in Winston Salem increased 5.1% from 2024 to 2023, versus a 42% year-over-year increase in aggregate Medicaid claim categories during that same period in the city.
According to the Centers for Medicare & Medicaid Services, federal and state Medicaid expenditures totaled approximately $871.7 billion in fiscal 2023, amounting to nearly 18% of the nation’s total health care outlay, and up sharply from roughly $613.5 billion in 2019 prior to the onset of COVID-19.
This signifies a growth rate near 40% over a few years, largely spurred by increased enrollment and higher health care use during and following the pandemic.
Recent federal budgets passed under the Trump administration have included wide-ranging proposals curbing federal Medicaid investment and redirecting its structure. One example, the “One Big Beautiful Bill Act,” enacted in 2025, is forecast to decrease federal Medicaid payments by over $1 trillion over a decade, implementing work requirements and stepped-up cost sharing that may result in less coverage and fewer resources for some participants. These adjustments could result in increased state responsibility and restrain further federal Medicaid growth, while the program continues to support millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,025,197 | -12.8% |
| 2021 | $1,098,969 | 7.2% |
| 2022 | $1,200,131 | 9.2% |
| 2023 | $1,406,772 | 17.2% |
| 2024 | $1,478,469 | 5.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Alcohol and Drug Abuse Treatment | $1,944,452 | 22.6% |
| 2 | National Codes Established for State Medicaid Agencies | $1,886,394 | 21.9% |
| 3 | Medicine Services and Procedures | $1,573,560 | 18.3% |
| 4 | Evaluation and Management | $1,478,469 | 17.2% |
| 5 | Surgery | $590,893 | 6.9% |
| 6 | Ambulance and Other Transport Services and Supplies | $224,231 | 2.6% |
| 7 | Durable Medical Equipment | $190,151 | 2.2% |
| 8 | Enteral and Parenteral Therapy | $180,763 | 2.1% |
| 9 | Dental Services | $178,473 | 2.1% |
| 10 | Pathology and Laboratory Procedures | $134,889 | 1.6% |
| 11 | Anesthesia | $107,461 | 1.2% |
| 12 | Medical And Surgical Supplies | $37,748 | 0.4% |
| 13 | Temporary Codes | $36,881 | 0.4% |
| 14 | Orthotic Procedures and services | $21,061 | 0.2% |
| 15 | Radiology Procedures | $10,573 | 0.1% |
| 16 | Drugs Administered Other than Oral Method | $7,419 | 0.1% |
| 17 | Procedures / Professional Services | $68 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99285 | Emergency dept visit hi mdm | $901,306 | 231 |
| 99284 | Emergency dept visit mod mdm | $337,998 | 162 |
| 99214 | Office o/p est mod 30 min | $134,402 | 135 |
| 99204 | Office o/p new mod 45 min | $56,606 | 30 |
| 99213 | Office o/p est low 20 min | $29,366 | 17 |
| 99199 | Unlisted special svc px/rprt | $10,734 | 30 |
| 99291 | Critical care first hour | $2,488 | 2 |
| 99244 | Off/op cnsltj new/est mod 40 | $1,923 | 1 |
| 99283 | Emergency dept visit low mdm | $1,894 | 3 |
| 99406 | Behav chng smoking 3-10 min | $1,196 | 15 |
| 99212 | Office o/p est sf 10 min | $551 | 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.
