Mount Horeb Medicaid providers billed $4,173 for Evaluation and Management services in 2024

Mount Horeb Medicaid providers submitted $4,173 in claims for Evaluation and Management services in 2024, the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents a 34% increase from 2023, when providers billed $3,114 for the same services.

Medicaid is a state-run public insurance program jointly funded by federal and state governments. It supports low-income individuals and families, seniors, children, and people with disabilities, and constitutes a major component of the U.S. health care system.

Since Medicaid dollars are funded by taxpayers, trends in local billing reflect community allocation of public health care funding.

The Evaluation and Management category consists of Medicaid-billed services defined by specific types of care, using standardized HCPCS and CPT code groups. For this analysis, each billing code is assigned to a single service group based on consistent prefixes and numeric ranges, allowing analysis by related service types without double counting, and preserving trends in category rankings over time.

Though Medicaid spending saw gains in multiple service categories, Evaluation and Management placed fourth in Mount Horeb for total Medicaid payments in 2024.

Across Wisconsin, Evaluation and Management ranked as the second largest Medicaid payment category statewide for 2024.

Over the five years up to 2024, Medicaid payments for Evaluation and Management services in Mount Horeb rose by $1,449, or 53.2%. Periods such as 2021 and 2020 saw particularly strong year-over-year growth.

While care in the Evaluation and Management category was billed throughout the city, the payments were concentrated in a select number of ZIP codes. In 2024, ZIP code 53572 contributed $4,172, representing 100% of Medicaid payments connected to Evaluation and Management services in Mount Horeb for the year.

Payments in the Evaluation and Management category were also highly concentrated among a small set of individual billing codes.

Between 2024 and 2023, Mount Horeb’s Medicaid payments for Evaluation and Management services rose 34%, outpacing the 26.3% increase across all Medicaid claim categories in the city over the same timeframe.

According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached approximately $871.7 billion in fiscal year 2023, which was about 18% of all U.S. national health expenditures, up sharply from $613.5 billion in 2019, prior to the COVID-19 pandemic.

This represents an increase of nearly 40% within a few years, primarily due to expanded enrollment and higher use of services during and after the pandemic.

Recent federal budget measures under the Trump administration have included proposals to reduce Medicaid funding from the federal government and alter the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to cut federal Medicaid spending by more than $1 trillion over the next 10 years. It also brings in policies such as work requirements and increased cost-sharing, which could reduce funding and coverage for some beneficiaries. These changes are projected to increase state financial responsibility while limiting federal Medicaid growth, even as the program continues serving 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.