Ephraim Medicaid Evaluation and Management payments up 161.9% to $46,624 in 2024

In 2024, Medicaid providers in Ephraim billed a total of $46,624 for services under the Evaluation and Management category, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 161.9% increase from 2023, when providers submitted $17,800 in claims for the same category.

Medicaid, a public health insurance program run by states with joint federal and state funding, serves low-income families and individuals, seniors, children, and people living with disabilities. This program is one of the primary elements of the U.S. health care system, as explained by the Commonwealth Fund.

Since Medicaid spending is funded by taxpayers, fluctuations in local billing reflect how public health care resources are distributed within a community.

The “Evaluation and Management” group includes a range of Medicaid-billed services categorized by care type, using standard HCPCS and CPT code groupings. For this data review, each billing code was organized into a single service category through the use of consistent code prefixes and numeric ranges. This process allowed for effective grouping of related services, which limited double counting and ensured accurate year-over-year rankings.

Among all Medicaid categories, Evaluation and Management was second in total Medicaid payments in Ephraim for 2024.

Statewide, Evaluation and Management ranked third among Medicaid categories by total 2024 payments in Utah.

Across the five years preceding 2024, Medicaid payments for Evaluation and Management services in Ephraim grew by $14,981, or 47.3%. Some periods within this timeframe saw more rapid growth, with year-over-year spikes noted in 2021 and 2020.

While Evaluation and Management payments were distributed throughout Ephraim, they were especially concentrated in certain ZIP codes. In 2024, ZIP code 84627 reported the highest total at $46,623. The top ZIP code made up 100% of all Medicaid payments in this category during the year in Ephraim.

Likewise, only a limited set of individual billing codes accounted for most Medicaid payments under the Evaluation and Management category.

For context, the 161.9% increase in Evaluation and Management payments between 2024 and 2023 compares to an 8.1% change across all Medicaid claim categories in Ephraim for the same time period.

The Centers for Medicare & Medicaid Services report that combined federal and state Medicaid expenditures reached about $871.7 billion in fiscal year 2023, making up roughly 18% of total national health costs. This was a significant increase from about $613.5 billion in 2019, before the COVID-19 pandemic.

This rise represents growth of around 40% over a few years, primarily due to expanded enrollment and higher health service utilization during and after the pandemic.

Recent federal budget legislation during the Trump administration introduced major plans to reduce federal Medicaid funding and revise the program structure. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to cut over $1 trillion in federal Medicaid spending over the next decade. The act also brings in policies like work requirements and increased cost-sharing, potentially reducing coverage and funding for some recipients. These adjustments could lead to states assuming more costs and restrict the rate of federal Medicaid support, all while millions of Americans remain covered through the program.

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.