Etowah providers billed $217,612 to Medicaid for Evaluation and Management services during 2024, according to U.S. Department of Health and Human Services Medicaid Provider Spending database figures. This represents an increase of 797.9% compared with the prior year, when claims totaling $24,235 were filed for the same category.
Medicaid, a public health insurance program administered at the state level and funded jointly by federal and state governments, serves low-income people and families, older adults, children, and individuals with disabilities, making it a major component of the U.S. health care system.
Because taxpayer funds pay for Medicaid, fluctuations in local billing highlight how public resources for health services are distributed in a region.
The “Evaluation and Management” group captures a set of Medicaid-billed services described by care type and defined through standard HCPCS and CPT numerical groupings. For this study, service categories were identified based on billing code prefixes and number ranges, ensuring each claim was counted under a single service grouping while keeping comparisons accurate each year.
Although Medicaid expenditures rose across various service types, Evaluation and Management saw the highest total Medicaid payments in Etowah for 2024.
Statewide in Tennessee, Evaluation and Management ranked second by Medicaid payment total for the year.
Across the five years ending in 2024, Evaluation and Management Medicaid payments in Etowah rose by $175,506, a 416.8% change. Annual increases for this group were particularly notable between 2022 and 2023.
Within Etowah, payments for Evaluation and Management services were mainly concentrated in a small number of ZIP codes. In 2024, the highest-paying ZIP code was 37331, which accounted for the entire $217,612 billed during the year.
Just a few specific billing codes made up the majority of Evaluation and Management-related Medicaid payments in Etowah.
For context, Evaluation and Management Medicaid payments in Etowah grew 797.9% between 2023 and 2024, compared with a 994% change for all Medicaid claim categories across the city during the period.
The Centers for Medicare & Medicaid Services reported that combined federal and state Medicaid expenses reached approximately $871.7 billion in the 2023 fiscal year, making up nearly 18% of national health spending, up from about $613.5 billion in 2019, before the COVID-19 outbreak.
This represents growth of about 40% in a few years, resulting mostly from additional enrollment and increased usage both during and after the pandemic.
Budget legislation in the Trump administration included significant efforts to curtail federal Medicaid support and revise the program’s structure. The “One Big Beautiful Bill Act,” approved in 2025, is forecasted to reduce federal Medicaid funding by over $1 trillion during the next 10 years while introducing new policies such as work requirements and higher cost-sharing, which may lower coverage and assistance for some recipients. These changes are likely to require states to assume a larger share of cost, reducing federal Medicaid support growth even as the program continues to cover millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $42,106 | -30.2% |
| 2021 | $23,479 | -44.2% |
| 2022 | $14,406 | -38.6% |
| 2023 | $24,234 | 68.2% |
| 2024 | $217,612 | 797.9% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $217,612 | 82% |
| 2 | Medicine Services and Procedures | $45,611 | 17.2% |
| 3 | Procedures / Professional Services | $2,009 | 0.8% |
| 4 | Surgery | $32 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99493 | Sbsq psyc collab care mgmt | $60,738 | 8 |
| 99426 | Prin care mgmt staff 1st 30 | $35,612 | 6 |
| 99483 | Assmt & care pln pt cog imp | $32,495 | 10 |
| 99427 | Prin care mgmt staff ea addl | $31,474 | 6 |
| 99214 | Office o/p est mod 30 min | $19,405 | 16 |
| 99425 | Prin care mgmt phys ea addl | $8,763 | 6 |
| 99213 | Office o/p est low 20 min | $7,300 | 10 |
| 99487 | Cplx chrnc care 1st 60 min | $5,813 | 12 |
| 99489 | Cplx chrnc care ea addl 30 | $3,532 | 12 |
| 99424 | Prin care mgmt phys 1st 30 | $3,070 | 6 |
| 99402 | Prev med cnsl indiv apprx 30 | $2,577 | 4 |
| 99212 | Office o/p est sf 10 min | $2,262 | 7 |
| 99494 | 1st/sbsq psyc collab care | $1,399 | 1 |
| 99395 | Prev visit est age 18-39 | $1,255 | 3 |
| 99396 | Prev visit est age 40-64 | $987 | 2 |
| 99497 | Advncd care plan 30 min | $461 | 2 |
| 99490 | Chrnc care mgmt staff 1st 20 | $358 | 5 |
| 99406 | Behav chng smoking 3-10 min | $101 | 3 |
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.
