Sister Bay Medicaid providers receive $2,769 for Evaluation and Management services in 2024

Sister Bay Medicaid providers received $2,769 for services categorized under Evaluation and Management in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This reflects a 19.4% rise from 2023, when $2,319 was billed under the same category.

Medicaid, a public health insurance program managed by the states and funded jointly by federal and state governments, serves low-income individuals and families, seniors, children, and people with disabilities. It remains one of the largest segments of the U.S. health care system.

As Medicaid expenditures come from taxpayers, local changes in billing levels reflect the allocation of public health care dollars in communities.

The Evaluation and Management category includes a set of Medicaid services defined by the type of care, using standardized HCPCS and CPT code groups. This report assigned each billing code to a unique service category by applying consistent code prefixes and numeric ranges, grouping related services for analysis while preventing overlap and maintaining accurate historical rankings.

Evaluation and Management was the highest Medicaid payment category in Sister Bay in 2024, with spending growth also seen in other service categories.

Statewide in Wisconsin, Evaluation and Management was ranked the second highest category by total Medicaid payments in 2024.

From five years prior to 2024, Medicaid payments attributed to Evaluation and Management in Sister Bay increased by $1,792, or 183.5%. The growth rate picked up during particular periods, with significant annual increases reported in 2021 and 2022.

Spending for Evaluation and Management services was seen throughout the city, but most payments came from a small number of ZIP codes. ZIP code 54234 recorded the entire $2,769 for this category in 2024, representing 100% of Medicaid payments for Evaluation and Management in Sister Bay that year.

Payments within the Evaluation and Management category were concentrated among a few specific Medicaid billing codes.

Medicaid spending for Evaluation and Management in Sister Bay increased by 19.4% between 2024 and 2023, matching the 19.4% rise across all Medicaid claim categories locally during that period.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures totaled approximately $871.7 billion in fiscal year 2023. This amount made up about 18% of total U.S. health spending and was a sharp increase from the $613.5 billion reported in 2019, ahead of the COVID-19 pandemic.

This jump equates to about 40% growth in just a few years, mainly due to expanded enrollment and increased service usage during and after the pandemic.

In recent years, major proposals to reduce federal Medicaid funding and alter program structure were included in budget legislation under the Trump administration. One example, the “One Big Beautiful Bill Act,” enacted in 2025, is set to reduce federal Medicaid outlays by over $1 trillion through the next decade and introduces measures such as work requirements and increased beneficiary cost-sharing, which may decrease coverage and funding for some individuals. These policy changes are expected to shift more costs to states and restrict federal Medicaid growth, while the program continues serving millions nationwide.

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.