In 2024, Medicaid providers in Nashville billed $1,011,360 for Evaluation and Management services, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represented a 27% increase over 2023, when providers billed $796,503 for these services.
Medicaid functions as a public health insurance program, with oversight by states and funding provided jointly by federal and state governments. The program offers coverage to low-income individuals and families, seniors, children, and those with disabilities, making it a central part of the U.S. health care system.
Because Medicaid funding relies on taxpayer dollars, shifts in local billing levels illustrate how public health care resources are allocated within a community.
The “Evaluation and Management” classification encompasses a set of Medicaid-billed services identified by the type of care given, as defined by standardized HCPCS and CPT code groups. For this report, each billing code was assigned to a single service grouping through use of consistent code prefixes and ranges to support accurate tracking and avoid double counting.
Spending through Medicaid rose in several service categories, but Evaluation and Management placed third by total Medicaid payments in Nashville during 2024.
Statewide in North Carolina, Evaluation and Management ranked second overall for Medicaid payments in 2024.
Between 2019 and 2024, Medicaid payments associated with Evaluation and Management in Nashville saw an increase of $922,840, or 1042.5%. Several years during this period included sharply higher year-over-year jumps in 2021 and 2022.
Evaluation and Management service payments were distributed across Nashville but heavily concentrated in a few ZIP codes. In 2024, ZIP code 27856 alone accounted for $1,011,360 in Medicaid payments. Altogether, the leading ZIP code accounted for 100% of the city’s Medicaid payments tied to Evaluation and Management services during the year.
Most Medicaid payments in the Evaluation and Management category were focused on a small group of unique billing codes.
Medicaid payments for Evaluation and Management services in Nashville jumped by 27% between 2024 and 2023, while payments across all Medicaid claim categories in the city grew by only 1.6% during the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled approximately $871.7 billion in fiscal year 2023, making up about 18% of total national health care expenditures. This was a significant increase from the $613.5 billion level recorded in 2019 before the COVID-19 pandemic.
This increase represents about 40% growth over a few years, attributed largely to expanded Medicaid enrollment and heightened utilization during and following the pandemic period.
Congress passed federal budget legislation during the Trump administration that included provisions to cut federal Medicaid payments and overhauled parts of the program. The “One Big Beautiful Bill Act,” enacted in 2025, is set to cut over $1 trillion in federal Medicaid funding over the next decade and brings policies including work requirements and greater cost-sharing, which may restrict coverage and funding for certain enrollees. As a result, states could bear a greater share of Medicaid costs even if federal support growth slows, and the program continues to cover tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $88,520 | -10.9% |
| 2021 | $390,428 | 341.1% |
| 2022 | $707,076 | 81.1% |
| 2023 | $796,503 | 12.6% |
| 2024 | $1,011,360 | 27% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Vision Services | $5,494,545 | 62.6% |
| 2 | Medicine Services and Procedures | $1,367,677 | 15.6% |
| 3 | Evaluation and Management | $1,011,360 | 11.5% |
| 4 | National Codes Established for State Medicaid Agencies | $428,301 | 4.9% |
| 5 | Temporary National Codes (Non-Medicare) | $346,185 | 3.9% |
| 6 | Pathology and Laboratory Procedures | $114,895 | 1.3% |
| 7 | Surgery | $5,187 | 0.1% |
| 8 | Drugs Administered Other than Oral Method | $4,732 | 0.1% |
| 9 | Radiology Procedures | $1,856 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99199 | Unlisted special svc px/rprt | $578,694 | 24 |
| 99213 | Office o/p est low 20 min | $159,192 | 42 |
| 99203 | Office o/p new low 30 min | $75,800 | 29 |
| 99214 | Office o/p est mod 30 min | $54,778 | 24 |
| 99391 | Per pm reeval est pat infant | $42,455 | 12 |
| 99392 | Prev visit est age 1-4 | $35,756 | 12 |
| 99395 | Prev visit est age 18-39 | $18,820 | 9 |
| 99211 | Off/op est may x req phy/qhp | $13,690 | 12 |
| 99393 | Prev visit est age 5-11 | $12,130 | 6 |
| 99394 | Prev visit est age 12-17 | $8,015 | 5 |
| 99381 | Init pm e/m new pat infant | $3,756 | 3 |
| 99383 | Prev visit new age 5-11 | $3,034 | 2 |
| 99309 | Sbsq nf care moderate mdm 30 | $1,732 | 3 |
| 99307 | Sbsq nf care sf mdm 10 | $1,331 | 2 |
| 99382 | Init pm e/m new pat 1-4 yrs | $1,260 | 1 |
| 99173 | Visual acuity screen | $912 | 12 |
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.
