In 2024, Medicaid providers in Morganton billed a total of $10,179,310 for services classified under the Evaluation and Management category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents a 19% rise from 2023, when providers submitted $8,551,858 in claims for the same category of service.
Medicaid is a public health insurance initiative managed by individual states and funded through a partnership between federal and state governments. The program serves people with low income, seniors, children, and people with disabilities, making it a major component of the U.S. health care infrastructure.
Because taxpayer funding supports Medicaid, local changes in billing amounts offer a view into how public health care resources are distributed in a given community.
The “Evaluation and Management” category groups Medicaid-billed services based on the type of care, using standardized HCPCS and CPT code classifications. Each billing code was assigned to only one service category through uniform prefixes and number ranges for this analysis, helping to review related services together, avoid double-counting, and maintain consistent rankings across years.
While several Medicaid service categories saw higher spending, Evaluation and Management was the second-largest by total Medicaid payments in Morganton for 2024.
Statewide in North Carolina, the Evaluation and Management category also placed second in total Medicaid payments for 2024.
Over the five years ending in 2024, Medicaid payments for the Evaluation and Management category in Morganton rose by $6,468,628, or 174.3%. Growth sped up during specific periods, with especially large year-over-year increases in 2021 and 2022.
Although the dollars spent in the Evaluation and Management category covered the city as a whole, most payments were focused within a few ZIP codes. In 2024, ZIP code 28655 alone accounted for $10,179,309 in these payments, representing 100% of Morganton’s Medicaid payments in the category for that year.
Within the Evaluation and Management group, Medicaid spending was concentrated on a small number of unique billing codes.
Comparatively, while Medicaid payments tied to the Evaluation and Management category in Morganton rose by 19% from 2023 to 2024, payments across all Medicaid claim categories in the city increased by 9% in that period.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached approximately $871.7 billion in fiscal year 2023, accounting for around 18% of the nation’s health expenditures. That is up substantially from $613.5 billion in 2019, ahead of the COVID-19 pandemic.
This reflects a growth of roughly 40% over a few years, largely due to greater enrollment and increased use during and after the pandemic.
Budget legislation enacted during the Trump administration has contained notable plans to scale back federal Medicaid funding and reshape the program. The “One Big Beautiful Bill Act,” enacted in 2025, is projected to trim over $1 trillion in federal Medicaid support over the coming decade and implements policies such as work requirements and higher cost-sharing, which may reduce coverage and funding for some participants. Such provisions are expected to shift a greater financial burden onto states and restrict increased federal Medicaid spending, even as the program continues to cover tens of millions of people in the U.S.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $3,710,682 | -28.1% |
| 2021 | $6,862,967 | 85% |
| 2022 | $8,406,102 | 22.5% |
| 2023 | $8,551,857 | 1.7% |
| 2024 | $10,179,309 | 19% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Alcohol and Drug Abuse Treatment | $12,445,463 | 32.4% |
| 2 | Evaluation and Management | $10,179,309 | 26.5% |
| 3 | Medicine Services and Procedures | $4,981,201 | 13% |
| 4 | National Codes Established for State Medicaid Agencies | $3,152,852 | 8.2% |
| 5 | Temporary National Codes (Non-Medicare) | $2,467,153 | 6.4% |
| 6 | Ambulance and Other Transport Services and Supplies | $1,093,967 | 2.9% |
| 7 | Enteral and Parenteral Therapy | $1,028,311 | 2.7% |
| 8 | Pathology and Laboratory Procedures | $942,938 | 2.5% |
| 9 | Dental Services | $767,202 | 2% |
| 10 | Radiology Procedures | $413,077 | 1.1% |
| 11 | Surgery | $356,411 | 0.9% |
| 12 | Medical And Surgical Supplies | $214,678 | 0.6% |
| 13 | Procedures / Professional Services | $148,973 | 0.4% |
| 14 | Durable Medical Equipment | $87,321 | 0.2% |
| 15 | Drugs Administered Other than Oral Method | $69,307 | 0.2% |
| 16 | Temporary Codes | $13,947 | <0.1% |
| 17 | Anesthesia | $2,603 | <0.1% |
| 18 | Administrative, Miscellaneous and Investigational | $10 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99199 | Unlisted special svc px/rprt | $3,462,395 | 177 |
| 99214 | Office o/p est mod 30 min | $1,411,195 | 590 |
| 99283 | Emergency dept visit low mdm | $1,343,031 | 152 |
| 99213 | Office o/p est low 20 min | $987,156 | 415 |
| 99284 | Emergency dept visit mod mdm | $919,197 | 126 |
| 99417 | Prolng op e/m each 15 min | $260,151 | 11 |
| 99282 | Emergency dept visit sf mdm | $223,398 | 110 |
| 99215 | Office o/p est hi 40 min | $206,852 | 53 |
| 99285 | Emergency dept visit hi mdm | $178,671 | 42 |
| 99393 | Prev visit est age 5-11 | $178,549 | 84 |
| 99392 | Prev visit est age 1-4 | $166,387 | 86 |
| 99391 | Per pm reeval est pat infant | $162,391 | 83 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $154,028 | 68 |
| 99394 | Prev visit est age 12-17 | $110,197 | 50 |
| 99245 | Off/op consltj new/est hi 55 | $44,523 | 13 |
| 99244 | Off/op cnsltj new/est mod 40 | $43,262 | 23 |
| 99203 | Office o/p new low 30 min | $42,160 | 38 |
| 99460 | Init nb em per day hosp | $30,688 | 20 |
| 99401 | Prev med cnsl indiv apprx 15 | $29,470 | 17 |
| 99238 | Hosp ip/obs dschrg mgmt 30/< | $26,945 | 24 |
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.
