According to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database, Medicaid providers in Vernal billed $1,252,260 for services under the Evaluation and Management category in 2024. This represents a 25.7% jump compared to 2023, when the total reached $996,091 for the same category.
Medicaid, a public health insurance program, is administered by states and financed with federal and state funding. It serves low-income individuals and families, seniors, children and people with disabilities, making it a leading component of the U.S. health care system.
Fluctuations in local Medicaid billing highlight changes in how taxpayer-funded health care dollars are spent within a community.
The Evaluation and Management category groups Medicaid services based on specific care types, determined by standardized HCPCS and CPT code sets. For this analysis, each billing code was placed in one service category using consistent code prefixes and numeric range assignments to group related services and prevent double counting, ensuring accurate rankings over time.
Evaluation and Management was the second-largest Medicaid service category by total payments in Vernal for 2024, among multiple other categories that saw spending gains.
At the state level, Evaluation and Management services placed third in Utah by total Medicaid spending for 2024.
Between the five years preceding 2024, Vernal’s Medicaid payments connected to the Evaluation and Management category climbed by $115,394, or 10.2%. Certain years, such as 2021 and 2022, saw more rapid year-over-year increases.
Although care in this category was provided throughout Vernal, most payments were concentrated in a small number of ZIP codes. In 2024, ZIP code 84078 accounted for $1,252,260 in Medicaid payments, representing 100% of Evaluation and Management spending within the city that year.
The majority of Medicaid payments in the Evaluation and Management group were associated with a relatively small set of individual billing codes.
Comparatively, Vernal saw a 25.7% increase in Medicaid payments tied to Evaluation and Management services from 2023 to 2024, while the overall citywide increase across all Medicaid-claim categories was 4% during the same period.
According to the Centers for Medicare & Medicaid Services, the combined federal and state spend for Medicaid reached about $871.7 billion in fiscal year 2023. This accounted for about 18% of national health expenditures, up substantially from around $613.5 billion in 2019, before COVID-19.
This increase denotes nearly 40% growth over several years, largely influenced by expanded membership and greater use of services during and after the pandemic.
More recent federal budget legislation during the Trump administration aimed to reduce federal Medicaid spending through major proposals. The “One Big Beautiful Bill Act,” signed into law in 2025, is projected to decrease federal Medicaid funding by more than $1 trillion in the next decade and introduce measures such as work requirements and higher cost-sharing that could affect some beneficiaries’ coverage and funding. These policy changes are anticipated to shift additional costs to states and slow federal Medicaid funding growth even as the program continues to support tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,136,866 | -0.5% |
| 2021 | $1,297,183 | 14.1% |
| 2022 | $1,158,436 | -10.7% |
| 2023 | $996,090 | -14% |
| 2024 | $1,252,260 | 25.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Medicine Services and Procedures | $1,998,778 | 45.8% |
| 2 | Evaluation and Management | $1,252,260 | 28.7% |
| 3 | Alcohol and Drug Abuse Treatment | $582,720 | 13.4% |
| 4 | National Codes Established for State Medicaid Agencies | $321,123 | 7.4% |
| 5 | Dental Services | $103,785 | 2.4% |
| 6 | Anesthesia | $42,254 | 1% |
| 7 | Pathology and Laboratory Procedures | $27,280 | 0.6% |
| 8 | Vision Services | $26,304 | 0.6% |
| 9 | Radiology Procedures | $4,710 | 0.1% |
| 10 | Durable Medical Equipment | $1,857 | <0.1% |
| 11 | Surgery | $1,039 | <0.1% |
| 12 | Procedures / Professional Services | $157 | <0.1% |
| 13 | Medical And Surgical Supplies | $17 | <0.1% |
| 14 | Drugs Administered Other than Oral Method | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $563,426 | 94 |
| 99214 | Office o/p est mod 30 min | $234,510 | 67 |
| 99284 | Emergency dept visit mod mdm | $205,900 | 39 |
| 99212 | Office o/p est sf 10 min | $68,536 | 17 |
| 99285 | Emergency dept visit hi mdm | $64,648 | 11 |
| 99391 | Per pm reeval est pat infant | $36,517 | 23 |
| 99283 | Emergency dept visit low mdm | $18,557 | 10 |
| 99203 | Office o/p new low 30 min | $18,240 | 14 |
| 99392 | Prev visit est age 1-4 | $17,343 | 10 |
| 99393 | Prev visit est age 5-11 | $12,070 | 7 |
| 99204 | Office o/p new mod 45 min | $6,463 | 4 |
| 99211 | Off/op est may x req phy/qhp | $3,866 | 9 |
| 99394 | Prev visit est age 12-17 | $2,177 | 1 |
Note: HCPCS codes are provided for context within the category. Totals and rankings rely on standardized category groupings, not individual billing codes.
This article’s information comes from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data is available here.
