Durham providers bill $48 million for Medicaid evaluation and management services in 2024

In 2024, Medicaid providers in Durham billed $48,450,044 for services classified as Evaluation and Management, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This amount was up 36.7% from 2023, when claims for these services totaled $35,451,659.

Medicaid is a government health insurance program administered by states and funded through a partnership between federal and state governments. It provides coverage for low-income households, seniors, children and individuals with disabilities, making it a major component of the U.S. health care system.

Since Medicaid is financed by taxpayers, variations in local billing highlight how health care funds are distributed in communities.

The “Evaluation and Management” category groups Medicaid-billed services based on the type of care delivered, using standardized HCPCS and CPT codes. This review assigned each code to a single service category using consistent prefixes and number ranges, ensuring groupings remained accurate and that services did not overlap when analyzed over time.

While Medicaid spending went up in several service categories, Evaluation and Management was the third-largest in Durham by total payments in 2024.

For North Carolina as a whole, Evaluation and Management was the second-highest Medicaid payment category for the year.

In the five-year period through 2024, Medicaid payments in this category in Durham climbed by $28,892,446, or 147.7%. The pace of spending growth increased in certain years, with significant rises in 2021 and 2022.

Spending for Evaluation and Management care occurred across Durham but was highly concentrated in a small number of ZIP codes during 2024. The ZIP codes with the largest Medicaid payments attributed to Evaluation and Management included 27710 at $23,422,263, 27704 at $10,347,912, and 27707 at $6,095,583. Combined, the top 3 ZIP codes made up 82.3% of the city’s total Medicaid payments in this service category for the year.

Within the Evaluation and Management category, most Medicaid payments were linked to a select set of billing codes.

To compare, Medicaid payments in Durham for Evaluation and Management services rose by 36.7% from 2024 to 2023, while the increase across all Medicaid claim categories in the city was 8.8% for the same time frame.

The Centers for Medicare & Medicaid Services reports that federal and state Medicaid spending reached approximately $871.7 billion in fiscal 2023, accounting for about 18% of the nation’s total health costs, a notable jump from $613.5 billion in 2019, before the COVID-19 pandemic.

This represents roughly 40% growth in several years, largely due to increased enrollment and higher usage during and after the pandemic.

Federal budget legislation enacted during the Trump administration recently included major proposals to decrease federal Medicaid funding and change the program structure. The “One Big Beautiful Bill Act,” which became law in 2025, is projected to reduce federal Medicaid funds by over $1 trillion over 10 years. The act includes policies such as work requirements and higher cost-sharing that could curtail funding and coverage for some recipients. These measures are expected to shift costs to individual states and limit the growth of federal support for Medicaid, even as millions continue to rely on the program.

Note: HCPCS codes are provided for category context. Article totals and rankings are based on standardized groupings, not individual billing codes.

Source data for this article are from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original source can be accessed here.