Wilson sees 2.6% uptick in Medicaid Evaluation and Management payments in 2024

In 2024, Medicaid providers in Wilson billed $9,502,308 for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 2.6% rise from 2023, when claims for the same service totaled $9,265,572.

Medicaid is a public health insurance program managed by states and funded jointly by state and federal governments. The program covers individuals and families with low incomes, older adults, children, and people with disabilities, positioning it among the largest components of the U.S. health care system.

Because Medicaid relies on taxpayer funding, fluctuations in local billing levels reflect how public health care resources are distributed within a community.

The “Evaluation and Management” category comprises a set of Medicaid-billed services identified by the care provided, using standardized HCPCS and CPT coding systems. For this report, each billing code was assigned to a single service grouping using defined code prefixes and number ranges, ensuring related services are reviewed together and double-counting is avoided while maintaining accurate rankings over time.

While Medicaid spending grew across several service lines, Evaluation and Management stood as the fourth highest category by total Medicaid payments in Wilson in 2024.

At the state level, Evaluation and Management ranked second for total Medicaid payments in North Carolina during 2024.

From 2019 through 2024, Medicaid payments for the Evaluation and Management category in Wilson climbed by $4,613,133, or 94.4%. Periods of accelerated spending growth occurred, including significant year-over-year increases in 2021 and 2022.

Although services in the Evaluation and Management group were provided citywide, most Medicaid payments were concentrated within specific ZIP codes. In 2024, ZIP code 27893 accounted for $8,970,576 and 27896 for $531,731, combining to represent 100% of Evaluation and Management Medicaid payments in Wilson that year.

Payments within the Evaluation and Management group were also focused among a few individual billing codes.

For reference, Medicaid payments tied to Evaluation and Management in Wilson rose 2.6% between 2024 and 2023. Across all Medicaid claim types in the city, the overall change was 3% in the same period.

According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid spending reached approximately $871.7 billion in fiscal year 2023, making up about 18% of national health expenditures—a sharp increase from $613.5 billion in 2019, before the COVID-19 pandemic.

This represents roughly 40% growth in just a few years, largely attributed to expanded program enrollment and increased utilization during and after the pandemic.

Recent federal budget legislation under the Trump administration introduced major proposals to decrease federal Medicaid funding and reorganize the structure of the program. The “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to reduce federal Medicaid spending by over $1 trillion over 10 years and includes work requirements and higher cost-sharing, potentially reducing coverage and funding for some enrollees. These measures are expected to shift more financial responsibility to states and constrain the rate of federal Medicaid growth, even as the program remains a vital service for tens of millions of Americans.

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.