Mount Sterling Medicaid providers billed $1,553,374 for Evaluation and Management services in 2024, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This figure represents a 2.5% increase from the 2023 total of $1,514,788 submitted for the same services.
Medicaid operates as a state-managed public health insurance program, co-funded by state and federal governments. The program serves low-income individuals and families, as well as seniors, children, and people with disabilities, making it a major component of the U.S. health care landscape.
Because Medicaid uses taxpayer funding, shifts in local billing amounts highlight how public health care funds are used within a community.
The Evaluation and Management category encompasses a range of Medicaid-billed services organized by care type, according to standardized HCPCS and CPT coding criteria. This analysis assigns each billing code to a single service group using consistent code prefixes and ranges, allowing tracking of related services without duplication and maintaining accurate historical rankings.
Spending on Medicaid rose in various service categories, with Evaluation and Management ranking as the largest Medicaid payment category in Mount Sterling during 2024.
Statewide in Kentucky, Evaluation and Management placed second for Medicaid payments in 2024.
Medicaid payments for Evaluation and Management services in Mount Sterling grew by $550,892 over the five years ending in 2024—an increase of 55%. Spending growth was particularly strong in certain years, including 2021 and 2020.
Although Evaluation and Management care payments were distributed throughout the city, the majority occurred in a small number of ZIP codes. In 2024, ZIP code 40353 accounted for $1,553,373. This single ZIP code represented 100% of Mount Sterling’s Medicaid Evaluation and Management payments for the year.
Within this category, Medicaid spending was also concentrated among a small set of individual billing codes.
Comparatively, Mount Sterling’s Medicaid Evaluation and Management payments increased by 2.5% from 2023 to 2024, whereas the overall Medicaid claims for all service categories saw no change within the city over the same period.
The Centers for Medicare & Medicaid Services report combined federal and state Medicaid spending of approximately $871.7 billion in fiscal 2023, making up about 18% of total U.S. health spending. This is a sharp rise from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This amounts to roughly 40% growth in several years, largely due to expanded enrollment and increased service use during and after the pandemic.
Recent federal budget actions under the Trump administration have included major proposals to cut federal Medicaid funding and change how the program is structured. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid outlays by more than $1 trillion over 10 years and introduces policies such as work requirements and higher cost-sharing that could lower coverage and funding for some recipients. These shifts are likely to pass more costs to states and restrict federal Medicaid assistance growth, despite the program continuing to serve millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,002,481 | 18.9% |
| 2021 | $1,193,464 | 19.1% |
| 2022 | $1,278,724 | 7.1% |
| 2023 | $1,514,787 | 18.5% |
| 2024 | $1,553,373 | 2.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $1,553,373 | 44.5% |
| 2 | Medicine Services and Procedures | $1,103,839 | 31.6% |
| 3 | Pathology and Laboratory Procedures | $521,267 | 14.9% |
| 4 | Dental Services | $130,840 | 3.8% |
| 5 | Vision Services | $107,322 | 3.1% |
| 6 | Radiology Procedures | $38,750 | 1.1% |
| 7 | Medical And Surgical Supplies | $20,873 | 0.6% |
| 8 | Procedures / Professional Services | $4,662 | 0.1% |
| 9 | Drugs Administered Other than Oral Method | $3,712 | 0.1% |
| 10 | National Codes Established for State Medicaid Agencies | $2,394 | 0.1% |
| 11 | Surgery | $1,874 | 0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $1,169,375 | 522 |
| 99214 | Office o/p est mod 30 min | $264,710 | 179 |
| 99391 | Per pm reeval est pat infant | $31,001 | 14 |
| 99203 | Office o/p new low 30 min | $29,112 | 27 |
| 99392 | Prev visit est age 1-4 | $18,036 | 14 |
| 99212 | Office o/p est sf 10 min | $12,674 | 22 |
| 99204 | Office o/p new mod 45 min | $9,386 | 8 |
| 99393 | Prev visit est age 5-11 | $4,675 | 5 |
| 99202 | Office o/p new sf 15 min | $4,659 | 6 |
| 99395 | Prev visit est age 18-39 | $3,422 | 4 |
| 99238 | Hosp ip/obs dschrg mgmt 30/< | $2,751 | 4 |
| 99394 | Prev visit est age 12-17 | $2,164 | 2 |
| 99051 | Med serv eve/wkend/holiday | $1,035 | 21 |
| 99231 | Sbsq hosp ip/obs sf/low 25 | $216 | 1 |
| 98960 | Edu&trn pt self-mgmt nqhp 1 | $152 | 1 |
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.
