In 2024, Medicaid providers in Lorton billed $234,509 for services within the Evaluation and Management category, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents a 4.8% uptick from 2023, when claims for these services reached $223,690.
Medicaid, a public health insurance service operated by states with shared federal and state financing, provides coverage for low-income people, seniors, children and individuals with disabilities—making it a major part of the U.S. health care landscape. Read more at the Commonwealth Fund.
As Medicaid funds are drawn from taxpayers, shifts in local billing illustrate how health care resources are distributed within communities.
The “Evaluation and Management” section covers an array of Medicaid services identified by type of care and standardized by HCPCS and CPT code groupings. This analysis assigned each code to one unique service group, using systematic code prefixes and numeric ranges to allow comparison of related services over time without overlap or duplication in category ranking.
Evaluation and Management came in as the second-highest Medicaid service category by total payments in Lorton for 2024, following growth in multiple claim types for the year.
Statewide in Virginia, Evaluation and Management held the third position by Medicaid payment totals in 2024.
From 2019 to 2024, Medicaid disbursements for Evaluation and Management in Lorton surged by $178,781, or 320.8%. Several periods saw faster gains, with notable year-over-year jumps occurring in both 2021 and 2022.
Spending for Evaluation and Management services was spread throughout Lorton, but highest payment amounts came from a small set of ZIP codes. In 2024, ZIP code 22079 accounted for all $234,509 in Medicaid payments for this category in Lorton—concentrating 100% of category payments within that ZIP code.
Payments in the Evaluation and Management group also focused heavily on only a few individual billing codes.
Between 2023 and 2024, Medicaid payments for Evaluation and Management services in Lorton were up 4.8%, while claims for all Medicaid service categories in the community increased 7.4% during the same timeframe.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures rose to about $871.7 billion for fiscal 2023, making up around 18% of the nation’s total health outlays—an increase from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This growth equals approximately 40% in just a few years, largely tied to higher enrollment and increased use of services during and after the pandemic.
Recent federal budget packages during the Trump administration have featured significant proposals to limit federal Medicaid funding and reshape the program. As an example, the “One Big Beautiful Bill Act,” enacted in 2025, aims to reduce federal Medicaid spending by more than $1 trillion over a decade, introducing measures such as work requirements and higher cost-sharing that could decrease both benefits and coverage for some enrollees. These adjustments are expected to transfer more financial responsibility to states and constrain future federal Medicaid funding while serving tens of millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $55,727 | 4.4% |
| 2021 | $141,087 | 153.2% |
| 2022 | $196,813 | 39.5% |
| 2023 | $223,689 | 13.7% |
| 2024 | $234,509 | 4.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $15,743,920 | 95.4% |
| 2 | Evaluation and Management | $234,509 | 1.4% |
| 3 | Durable Medical Equipment | $218,787 | 1.3% |
| 4 | Medical And Surgical Supplies | $209,660 | 1.3% |
| 5 | Ambulance and Other Transport Services and Supplies | $24,648 | 0.1% |
| 6 | Medicine Services and Procedures | $23,260 | 0.1% |
| 7 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $16,772 | 0.1% |
| 8 | Radiology Procedures | $14,364 | 0.1% |
| 9 | Vision Services | $11,083 | 0.1% |
| 10 | Drugs Administered Other than Oral Method | $3,323 | <0.1% |
| 11 | Surgery | $2,673 | <0.1% |
| 12 | Pathology and Laboratory Procedures | $1,937 | <0.1% |
| 13 | Dental Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $130,000 | 50 |
| 99203 | Office o/p new low 30 min | $30,380 | 25 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $25,274 | 19 |
| 99214 | Office o/p est mod 30 min | $17,797 | 12 |
| 99233 | Sbsq hosp ip/obs high 50 | $14,895 | 10 |
| 99204 | Office o/p new mod 45 min | $5,760 | 4 |
| 99222 | 1st hosp ip/obs moderate 55 | $5,666 | 6 |
| 99223 | 1st hosp ip/obs high 75 | $4,733 | 4 |
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.
