In 2024, Medicaid providers in Philippi billed $431,234 for services within the Evaluation and Management category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This total represented a 7.7% rise from 2023, when $400,306 in claims were submitted for comparable services.
Medicaid, operated by state governments with joint federal and state funding, is a public health insurance program. It provides coverage for low-income individuals and families, seniors, children, and people with disabilities, making it one of the nation’s largest health care programs. For more details on Medicaid funding, see here.
Since Medicaid payments come from public funds, changes in a community’s local billing offer insight into the distribution of public health care resources.
The “Evaluation and Management” category encompasses a set of Medicaid-billed services categorized by care type, as identified in standardized HCPCS and CPT code groupings. This analysis grouped billing codes under a single service category based on consistent code prefixes and numerical ranges, ensuring services were tracked together, without duplication, while maintaining accurate historical rankings.
Although Medicaid outlays increased across several categories, Evaluation and Management ranked as the second-largest category by Medicaid payments in Philippi for 2024.
Statewide, Evaluation and Management was also the second-highest category for Medicaid payments in West Virginia in 2024.
Between 2019 and 2024, Medicaid payments associated with Evaluation and Management services in Philippi went up by $52,468, or 10.8%. Spending growth accelerated during certain years, including notable increases in 2022 and 2020.
Evaluation and Management spending was dispersed throughout the city, but concentrated within a small set of ZIP codes. The 2024 data shows ZIP code 26416 accounted for $431,234 in Medicaid payments—making up 100% of all payments for Evaluation and Management services in Philippi that year.
Within Evaluation and Management, Medicaid payments were also focused on a small number of specific billing codes.
In Philippi, Medicaid payments connected to Evaluation and Management services increased by 7.7% between 2024 and 2023. By comparison, payments tied to all Medicaid claim categories in the city climbed 8% over the same period.
Centers for Medicare & Medicaid Services data shows combined federal and state Medicaid spending hit about $871.7 billion in fiscal 2023, or roughly 18% of total U.S. health spending—up steeply from $613.5 billion in 2019, before the COVID-19 pandemic.
This increase amounts to about 40% growth within just a few years, with expanded program enrollment and higher utilization both significant drivers during and after the pandemic.
Recent federal budget laws under the Trump administration introduced major proposals to trim federal Medicaid funding and reshape the program. The “One Big Beautiful Bill Act,” enacted in 2025, is projected to cut federal Medicaid spending by more than $1 trillion over the next ten years, and sets measures such as work mandates and higher cost-sharing requirements, which may shrink coverage and funding for certain beneficiaries. These adjustments are expected to shift added costs to the states and slow the growth of federal Medicaid investment even as the program continues to serve tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $483,701 | 23.7% |
| 2021 | $354,753 | -26.7% |
| 2022 | $497,176 | 40.1% |
| 2023 | $400,306 | -19.5% |
| 2024 | $431,234 | 7.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $1,154,631 | 59.7% |
| 2 | Evaluation and Management | $431,234 | 22.3% |
| 3 | Pathology and Laboratory Procedures | $205,804 | 10.6% |
| 4 | Radiology Procedures | $58,615 | 3% |
| 5 | Ambulance and Other Transport Services and Supplies | $51,334 | 2.7% |
| 6 | Medicine Services and Procedures | $25,465 | 1.3% |
| 7 | Alcohol and Drug Abuse Treatment | $2,880 | 0.1% |
| 8 | Procedures / Professional Services | $2,165 | 0.1% |
| 9 | Surgery | $1,439 | 0.1% |
| 10 | Drugs Administered Other than Oral Method | $236 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99283 | Emergency dept visit low mdm | $350,991 | 44 |
| 99284 | Emergency dept visit mod mdm | $69,910 | 18 |
| 99212 | Office o/p est sf 10 min | $7,115 | 26 |
| 99285 | Emergency dept visit hi mdm | $1,168 | 1 |
| 99308 | Sbsq nf care low mdm 20 | $1,165 | 7 |
| 99214 | Office o/p est mod 30 min | $560 | 68 |
| 99213 | Office o/p est low 20 min | $170 | 87 |
| 99309 | Sbsq nf care moderate mdm 30 | $152 | 1 |
| 99215 | Office o/p est hi 40 min | $0 | 2 |
| 99401 | Prev med cnsl indiv apprx 15 | $0 | 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.
