Pottsville sees 38.4% increase in Medicaid payments for Evaluation and Management in 2024

In 2024, Medicaid providers in Pottsville billed $19,669 for services within the Evaluation and Management category, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 38.4% rise from 2023, when claims for the same category totaled $14,213.

Medicaid, a public health insurance program operated by the states with joint federal and state funding, covers low-income individuals and families, seniors, children, and people with disabilities, making it one of the largest segments of the U.S. health care system. For further information, see the explainer by the Commonwealth Fund.

Since Medicaid funds are supplied by taxpayers, local shifts in billing levels directly reflect how public health care resources are distributed throughout a community.

The “Evaluation and Management” category includes various Medicaid-billed services identified by the type of care using standardized HCPCS and CPT code groupings. For the purposes of this analysis, each billing code was attributed to one service category based on consistent code prefixes and range assignments. This approach enables grouping related services for comparative analysis while ensuring data is not double-counted and rankings remain accurate over time.

Spending on Medicaid increased across several service categories, but Evaluation and Management was the highest-ranked by total Medicaid payments in Pottsville in 2024.

Statewide in Arkansas, Evaluation and Management ranked fifth among Medicaid payment categories in 2024.

Looking at the five-year period ending in 2024, Pottsville’s Medicaid payments for Evaluation and Management rose by $18,177, or 1217.9%. Periods of rapid growth were noted, particularly with significant annual increases in 2022 and 2023.

Although spending for Evaluation and Management services was distributed citywide, the majority of payments were concentrated in a few ZIP codes. In 2024, ZIP code 72858 alone accounted for $19,668 in Medicaid payments tied to this category, making up 100% of Pottsville’s total for the year.

Additionally, a limited number of individual billing codes saw the highest concentration of Medicaid payments in the Evaluation and Management category.

For reference, while the city saw a 38.4% increase year-over-year in Medicaid payments related to Evaluation and Management in Pottsville, all Medicaid claim categories combined posted a 12.5% change during the same period.

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

This change marks an estimated 40% growth in just a few years, fueled by increased enrollment and greater service use during and after the pandemic.

Federal budget legislation enacted during the Trump administration has advanced significant plans to reduce federal Medicaid funding and restructure the program. Notably, the “One Big Beautiful Bill Act,” signed in 2025, is expected to cut more than $1 trillion in federal Medicaid spending over ten years. The act introduces new policies such as work requirements and higher cost-sharing, potentially decreasing coverage and funding for some recipients. As a result, these changes could shift financial responsibility to states and constrain federal Medicaid growth, while the program remains crucial for 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.