Whitesboro Medicaid outlays for Evaluation and Management services rise to $165,756 in 2024

In 2024, Medicaid providers in Whitesboro billed a total of $165,756 for Evaluation and Management services, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This figure reflects a 71.1% increase from 2023, when claims for the same service category reached $96,865.

Medicaid is a public insurance program operated by states with financial support from federal and state governments. It provides coverage for low-income people, seniors, children, and individuals with disabilities, making it a major component of the U.S. health care landscape.

Because taxpayer funding supports Medicaid, changes in local billing provide insight into how public health care resources are distributed within a particular area.

The Evaluation and Management group includes Medicaid services categorized by the type of care rendered, based on established HCPCS and CPT code groups. For this report, individual billing codes were sorted into one service category each using defined code prefixes and numeric intervals, allowing services to be grouped consistently and minimizing double counting, which supports accurate year-over-year rankings.

Spending in several Medicaid service groups increased, but in Whitesboro the Evaluation and Management category claimed the top spot for Medicaid payments in 2024.

Statewide, Evaluation and Management ranked as the second-highest Medicaid payment category in New York for 2024.

Between 2019 and 2024, Medicaid payments for Evaluation and Management services in Whitesboro rose by $129,510, which amounts to a 357.3% increase. Rapid spending growth occurred during specific years, including significant jumps in 2021 and 2022.

The distribution of Evaluation and Management spending encompassed different parts of the city, but Medicaid payments were set primarily within a few ZIP codes. For 2024, ZIP code 13492 recorded the highest total, accounting for $165,755, and collectively the top 1 ZIP code was responsible for 100% of Medicaid payments in the Evaluation and Management category for Whitesboro that year.

Within the Evaluation and Management category, most Medicaid payments were linked to a small group of specific billing codes.

When compared with the 21.9% increase seen across all Medicaid claim categories in the city, Evaluation and Management spending in Whitesboro surged by 71.1% from 2023 to 2024.

Centers for Medicare & Medicaid Services data shows that total federal and state Medicaid spending reached around $871.7 billion in fiscal 2023, making up roughly 18% of national health expenditures—up from approximately $613.5 billion in 2019, prior to the COVID-19 pandemic.

This roughly 40% increase over a few years is attributed mainly to expanded enrollment and higher demand for services during and following the pandemic.

Recent federal legislation under the Trump administration introduced significant proposals to scale back federal Medicaid funding and alter the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid outlays by more than $1 trillion over the next 10 years and includes measures like work requirements and increased cost-sharing, potentially affecting coverage and federal funding for some recipients. These changes are projected to shift more financial responsibility to states and curb the rate of increase in federal support, even as the program remains vital for tens of millions of Americans.

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.