In 2024, Medicaid providers in Wake Forest billed $2,555,017 for Evaluation and Management category services, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This amount was 9.2% higher than in 2023, when claims for these services reached $2,339,907.
Medicaid, a public health insurance program operated by the states and financed in partnership between federal and state governments, provides coverage for low-income individuals and families, seniors, children and people with disabilities. This makes it a major component of the U.S. health care system.
Because taxpayer dollars fund Medicaid payments, changes in local billing reflect how public health care funds are distributed within communities.
The Evaluation and Management category consists of Medicaid-billed services organized by the type of care provided under standard HCPCS and CPT code groupings. To conduct this analysis, billing codes were assigned to one service category each, sorted by consistent code prefixes and numbers to group like services for accurate over-time rankings and to prevent double counting.
Even though multiple service categories saw increases in Medicaid spending, Evaluation and Management represented the second highest total among categories in Wake Forest in 2024.
Statewide in North Carolina, Evaluation and Management also held the second spot by total Medicaid payment volume that year.
From 2019 to 2024, Medicaid payments in Wake Forest associated with the Evaluation and Management category grew by $1,617,461, or 172.5%. The fastest growth periods included 2021 and 2022, which both saw significant year-on-year increases.
Although payments for Evaluation and Management care occurred throughout Wake Forest, the majority were concentrated in a small number of ZIP codes. During 2024, ZIP code 27587 alone totaled $2,555,017, and this one ZIP code accounted for 100% of Medicaid Evaluation and Management payments in the city that year.
Furthermore, within the Evaluation and Management category, spending was centered on a handful of individual billing codes.
When comparing category trends, Wake Forest’s 9.2% increase in Medicaid Evaluation and Management payments from 2023 to 2024 trailed the 15.6% growth observed for all Medicaid claim types locally for the same period.
Data from the Centers for Medicare & Medicaid Services shows federal and state Medicaid spending together reached about $871.7 billion in fiscal year 2023, roughly 18% of total U.S. national health outlays, a substantial climb from the $613.5 billion spent in 2019, prior to the COVID-19 pandemic.
The roughly 40% increase took place over only a few years, mostly as a result of expanded enrollment and increased use of services during and after the pandemic.
Recent federal budget laws enacted during the Trump administration included sweeping efforts to curb federal Medicaid funding and restructure the program. The “One Big Beautiful Bill Act,” signed in 2025, is expected to cut over $1 trillion from federal Medicaid funding throughout the next decade while implementing measures such as work requirements and greater cost-sharing for some beneficiaries. These policies are projected to increase the burden on states and slow the expansion of federal Medicaid support, though the program will continue to serve tens of millions across the nation.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $937,555 | -21.3% |
| 2021 | $1,734,817 | 85% |
| 2022 | $2,415,759 | 39.3% |
| 2023 | $2,339,906 | -3.1% |
| 2024 | $2,555,017 | 9.2% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Procedures / Professional Services | $4,218,249 | 35.1% |
| 2 | Evaluation and Management | $2,555,017 | 21.3% |
| 3 | National Codes Established for State Medicaid Agencies | $2,084,500 | 17.4% |
| 4 | Medicine Services and Procedures | $1,010,443 | 8.4% |
| 5 | Pathology and Laboratory Procedures | $861,244 | 7.2% |
| 6 | Alcohol and Drug Abuse Treatment | $843,040 | 7% |
| 7 | Dental Services | $350,179 | 2.9% |
| 8 | Temporary National Codes (Non-Medicare) | $49,173 | 0.4% |
| 9 | Radiology Procedures | $12,697 | 0.1% |
| 10 | Medical And Surgical Supplies | $11,290 | 0.1% |
| 11 | Anesthesia | $6,137 | 0.1% |
| 12 | Coronavirus Diagnostic Panel | $4,071 | <0.1% |
| 13 | Surgery | $3,445 | <0.1% |
| 14 | Temporary Codes | $296 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99199 | Unlisted special svc px/rprt | $1,374,756 | 128 |
| 99213 | Office o/p est low 20 min | $556,219 | 298 |
| 99214 | Office o/p est mod 30 min | $421,512 | 243 |
| 99392 | Prev visit est age 1-4 | $101,437 | 67 |
| 99393 | Prev visit est age 5-11 | $57,594 | 41 |
| 99391 | Per pm reeval est pat infant | $27,969 | 22 |
| 99394 | Prev visit est age 12-17 | $7,387 | 5 |
| 99173 | Visual acuity screen | $6,881 | 149 |
| 99406 | Behav chng smoking 3-10 min | $665 | 4 |
| 99212 | Office o/p est sf 10 min | $593 | 1 |
| 99000 | Specimen handling office-lab | $0 | 3 |
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.
