Pima Medicaid Evaluation and Management payments rise 27.6% in 2024

Pima Medicaid providers submitted $22,846 in claims for Evaluation and Management services in 2024, the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represented a 27.6% jump over 2023, when $17,909 in claims were filed for the same category.

Medicaid operates as a state-run, federally and state-funded public health insurance program. Covering low-income adults, families, seniors, children, and people with disabilities, the program remains a major component of the U.S. health care system.

As Medicaid funding comes from taxpayer dollars, local fluctuations in billing illustrate changes in the allocation of public health care resources in each community.

The Evaluation and Management service category comprises a range of Medicaid-billed services, classified by standardized HCPCS and CPT code sets. This review assigned each billing code to a specific service category based on consistent code prefixes and numeric designations for systematic grouping, which assists in tracking trends and ensures services were only counted once.

Evaluation and Management led all Medicaid spending categories in Pima in 2024 by total payment amount.

Statewide in Arizona, Evaluation and Management ranked third by Medicaid payments for the year.

Reviewing the past five years leading to 2024, Medicaid payments attached to the Evaluation and Management category in Pima climbed by $22,846, with no change in the overall total. Periodic surges—most notably in 2022 and 2023—contributed to periods of rapid growth.

Most payments for Evaluation and Management services in 2024 came from a few ZIP codes within the city. ZIP code 85543 posted $22,845 in Medicaid payments for the category, representing 100% of such expenditures across Pima for that year.

Payments within this category were also centered around a small subset of billing codes.

Medicaid payments for Evaluation and Management services in Pima increased 27.6% between 2023 and 2024. All Medicaid claim categories citywide reported a combined change of 14.9% over the same period.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023, making up roughly 18% of the U.S.’s overall health care expenditure. This figure marked a considerable rise from $613.5 billion in 2019, before the COVID-19 pandemic began.

This boost amounts to around 40% growth within several years, as enrollment expanded and service use increased in the wake of the pandemic.

Major federal budget laws passed during the Trump administration introduced proposals to cut Medicaid funding and reshape the program. The “One Big Beautiful Bill Act,” signed into law in 2025, is projected to trim federal Medicaid spending by more than $1 trillion over the next 10 years and adds requirements, such as work mandates and higher cost-sharing, that could reduce eligibility and funding for certain enrollees. These shifts are likely to place additional financial responsibility on states while slowing the growth of federal Medicaid aid, even as millions of Americans continue using the program.

Note: HCPCS codes are included for reference within the group. The article bases all category rankings and totals on standardized service groupings, not individual billing codes.

Information in this article was sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database, available here.