Data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows that Medicaid providers in Clark billed $5,971 for Evaluation and Management services in 2024. This amount represented a 75.4% rise compared with the $3,404 submitted for the same services in 2023.
Medicaid, a joint state and federal program, funds coverage for low-income residents, older adults, children, and people with disabilities. The program remains one of the nation’s largest health insurance systems.
Because Medicaid is taxpayer-funded, shifts in local billing reveal how public dollars for health care are distributed throughout communities.
The Evaluation and Management group includes various Medicaid services based on standardized HCPCS and CPT coding. For this report, each billing code was allocated to one service category using specific code prefixes and numerical groupings so related services could be analyzed comprehensively without double counting, ensuring accurate year-to-year rankings.
Spending increased in several service types, and Evaluation and Management was the second largest category by total Medicaid payments in Clark for 2024.
Evaluation and Management also ranked second by statewide Medicaid payments in South Dakota for 2024.
Between 2019 and 2024, Medicaid payments for Evaluation and Management services in Clark climbed by $433, reflecting a 7.8% gain. Spending growth escalated in some years, particularly with significant year-over-year increases in 2021 and 2022.
Spending on Evaluation and Management services was spread across Clark but was heavily focused within a small group of ZIP codes. In 2024, the highest Medicaid payments for this category came from ZIP code 57225, which accounted for $5,971. Collectively, the leading 1 ZIP codes made up 100% of the city’s Medicaid Evaluation and Management payments for the year.
Within this service category, Medicaid spending primarily went to a select group of individual billing codes.
When compared to the overall Medicaid claim categories in Clark, Evaluation and Management payments rose 75.4% from 2023 to 2024. In contrast, the total change across all Medicaid service types was 17.3% for the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached approximately $871.7 billion in fiscal year 2023, representing about 18% of all national health expenditures, an increase from $613.5 billion in 2019 prior to the onset of COVID-19.
This growth — around 40% since 2019 — primarily reflects heightened enrollment and greater use of services related to the pandemic.
Recent federal budget actions under the Trump administration involved major proposals to alter Medicaid funding and structure. The “One Big Beautiful Bill Act,” enacted in 2025, is on track to reduce federal Medicaid dollars by more than $1 trillion over the next ten years through policies such as adding work requirements and increasing cost-sharing, which could impact coverage and funding for some recipients. These adjustments are anticipated to increase state financial burdens while slowing federal support, even as millions continue to rely on Medicaid.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $5,538 | -64.2% |
| 2021 | $8,880 | 60.3% |
| 2022 | $4,891 | -44.9% |
| 2023 | $3,404 | -30.4% |
| 2024 | $5,971 | 75.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Dental Services | $6,646 | 52.7% |
| 2 | Evaluation and Management | $5,971 | 47.3% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $5,971 | 5 |
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.
