Medicaid providers in Monsey reported $7,319,421 in billings for Evaluation and Management services for 2024, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total reflects a 6.3% jump from 2023, when providers submitted $6,884,408 in claims for these services.
Medicaid, a public insurance program funded through a partnership of federal and state governments, covers low-income families and individuals, seniors, children, and those with disabilities. This makes Medicaid a core component of the U.S. health care framework.
Fluctuations in Medicaid billing levels highlight how taxpayer dollars support community health care services at the local level.
The “Evaluation and Management” category comprises a set of Medicaid-billed services sorted by type of care provided, using standardized HCPCS and CPT codes. For this analysis, each billing code was placed in a distinct service group using consistent code prefixes and number ranges to categorize services accurately without duplication and to allow year-to-year comparisons.
Spending via Medicaid rose in several service areas, with Evaluation and Management ranking as the second-highest category in terms of total payments for Monsey during 2024.
The Evaluation and Management category was also second statewide for Medicaid payments in New York for 2024.
Between 2019 and 2024, payments tied to the Evaluation and Management category in Monsey grew by $421,872, or 6.1%. Certain years, such as 2022 and 2021, saw especially strong year-over-year increases.
Medicaid payments for Evaluation and Management services were distributed throughout Monsey but clustered heavily in a small number of ZIP codes. In 2024, the 10952 ZIP code accounted for $7,319,421. This ZIP made up 100% of payments for the category in Monsey that year.
Spending within the Evaluation and Management group was also concentrated among a few individual billing codes.
For context, while Evaluation and Management payments in Monsey rose by 6.3% from 2023 to 2024, total Medicaid payments citywide across all categories changed by 13.6% over the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached about $871.7 billion in the 2023 fiscal year, accounting for roughly 18% of national health spending, up substantially from approximately $613.5 billion in 2019, before the COVID-19 pandemic.
That growth reflects a nearly 40% increase in spending in only a few years, largely driven by growth in enrollment and usage tied to the pandemic period and its aftermath.
Recent federal budget measures from the Trump administration included major proposals to decrease federal Medicaid funding and restructure the program. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to cut federal Medicaid payments by more than $1 trillion over the next decade. New policies in this legislation—such as work requirements and increased cost-sharing—could result in diminished coverage for some enrollees and place a greater share of program costs on the states while federal financial growth slows, despite Medicaid’s continued role serving tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $6,897,548 | 5.9% |
| 2021 | $7,705,635 | 11.7% |
| 2022 | $10,599,469 | 37.6% |
| 2023 | $6,884,408 | -35% |
| 2024 | $7,319,421 | 6.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $125,705,752 | 86.1% |
| 2 | Evaluation and Management | $7,319,421 | 5% |
| 3 | Medicine Services and Procedures | $3,682,484 | 2.5% |
| 4 | Alcohol and Drug Abuse Treatment | $2,838,247 | 1.9% |
| 5 | Orthotic Procedures and services | $1,783,431 | 1.2% |
| 6 | Ambulance and Other Transport Services and Supplies | $1,071,112 | 0.7% |
| 7 | Temporary National Codes (Non-Medicare) | $1,066,244 | 0.7% |
| 8 | Medical And Surgical Supplies | $1,056,197 | 0.7% |
| 9 | Surgery | $415,576 | 0.3% |
| 10 | Durable Medical Equipment | $380,005 | 0.3% |
| 11 | Dental Services | $357,581 | 0.2% |
| 12 | Vision Services | $137,189 | 0.1% |
| 13 | Pathology and Laboratory Procedures | $61,347 | <0.1% |
| 14 | Radiology Procedures | $43,719 | <0.1% |
| 15 | Procedures / Professional Services | $36,404 | <0.1% |
| 16 | Prosthetic Procedures | $20,173 | <0.1% |
| 17 | Temporary Codes | $515 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $3,319,906 | 329 |
| 99203 | Office o/p new low 30 min | $1,207,118 | 50 |
| 99214 | Office o/p est mod 30 min | $727,270 | 121 |
| 99204 | Office o/p new mod 45 min | $611,724 | 27 |
| 99199 | Unlisted special svc px/rprt | $268,779 | 4 |
| 99212 | Office o/p est sf 10 min | $235,696 | 124 |
| 99392 | Prev visit est age 1-4 | $190,667 | 42 |
| 99391 | Per pm reeval est pat infant | $149,806 | 31 |
| 99393 | Prev visit est age 5-11 | $130,429 | 48 |
| 99051 | Med serv eve/wkend/holiday | $130,282 | 65 |
| 99394 | Prev visit est age 12-17 | $73,373 | 31 |
| 99395 | Prev visit est age 18-39 | $62,841 | 18 |
| 99396 | Prev visit est age 40-64 | $55,602 | 18 |
| 99385 | Prev visit new age 18-39 | $46,595 | 11 |
| 99309 | Sbsq nf care moderate mdm 30 | $25,694 | 49 |
| 99441 | $24,007 | 30 | |
| 99202 | Office o/p new sf 15 min | $15,753 | 5 |
| 99386 | Prev visit new age 40-64 | $14,758 | 7 |
| 99381 | Init pm e/m new pat infant | $11,929 | 9 |
| 99211 | Off/op est may x req phy/qhp | $8,078 | 13 |
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.
