Berne sees $42,878 in Medicaid claims for Evaluation and Management services in 2024

In 2024, Medicaid providers in Berne billed a total of $42,878 for services falling under the Evaluation and Management category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 41.6% rise compared with the prior year, when $30,275 in claims were filed for the same service group.

Medicaid is a state-administered program financed with joint federal and state funds. It provides coverage to low-income populations, including families, seniors, children, and those with disabilities, making it a key part of national health care.

Because taxpayer funding supports Medicaid payments, shifts in local billing highlight how public health finances are allocated in specific communities.

The “Evaluation and Management” label encompasses a set of Medicaid-reimbursed services defined by the type of care offered, using standardized HCPCS and CPT code groupings. For this analysis, each billing code was assigned to one service group based on consistent code prefixes and numeric ranges, which enables analysis of related services, prevents duplication, and supports accurate comparisons over time.

Berne ranked Evaluation and Management as the top category by Medicaid payments in 2024, although other service groups also saw increased spending.

Statewide in New York, Evaluation and Management came in second for total Medicaid payment volume during 2024.

Between 2019 and 2024, Medicaid payments connected to Evaluation and Management services in Berne grew by $28,967, or 208.2%. Certain years saw pronounced growth, with especially notable increases in 2020 and 2023.

Although payment for Evaluation and Management services was distributed throughout Berne, the majority of funds were concentrated in specific ZIP codes. In 2024, ZIP code 12023 recorded $42,878, accounting for 100% of Medicaid payments to the Evaluation and Management category in the city.

Most Medicaid expenditures within the Evaluation and Management group were linked to a relatively small set of billing codes.

Year over year, Medicaid spending related to Evaluation and Management in Berne grew 41.6% between 2023 and 2024. All Medicaid claim categories in the city experienced a larger combined change of 53.2% during that span.

According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached approximately $871.7 billion in fiscal year 2023, representing close to 18% of national health expenditures, an increase from $613.5 billion in 2019, before the COVID-19 pandemic.

This marks about 40% growth over several years, largely due to higher enrollment and greater utilization driven by the pandemic and its aftermath.

Recent federal budget measures under the Trump administration have included significant plans to reduce federal support for Medicaid and change how the program is structured. As an example, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to decrease federal Medicaid expenditures by more than $1 trillion over the next 10 years. It also introduces changes such as work requirements and higher cost-sharing, which could impact coverage and funding for certain Medicaid recipients. These adjustments are set to shift higher costs to states and restrict the future growth of federal contributions, even as Medicaid remains essential 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.