Banner Elk Medicaid billing for Evaluation and Management services climbs to $92,798 in 2024

Banner Elk’s Medicaid providers billed $92,798 for Evaluation and Management services in 2024, as reported in the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 274.5% jump from 2023, when $24,776 in claims were submitted for the same category.

Medicaid is a government-supported health insurance program administered by individual states with joint federal and state funding, as outlined by the Commonwealth Fund. The program covers low-income populations, seniors, children and people with disabilities, making it a central component of U.S. health care.

Because taxpayer funding supports Medicaid payments, shifts in local billing reflect how public health care resources are used within communities.

The Evaluation and Management category consists of Medicaid services grouped by care type according to HCPCS and CPT code systems. For this report, each billing code was assigned to a unique service category using strict code prefixes and ranges, ensuring related services were grouped and avoiding duplicate counts, while maintaining accurate trends over time.

Spending was up across several Medicaid service categories, with Evaluation and Management leading Banner Elk in 2024 by total Medicaid payments.

Statewide, Evaluation and Management ranked as the second-highest service category for Medicaid spending in North Carolina in 2024.

During the five years before 2024, Evaluation and Management Medicaid payments in Banner Elk grew by $91,584, marking a 7542.2% increase. Several years, including 2021 and 2023, saw particularly strong year-over-year growth.

Although expenditure in this category reached across Banner Elk, Medicaid payments were notably concentrated in a small group of ZIP codes. ZIP code 28604 saw $92,797 in Medicaid payments for Evaluation and Management in 2024, making up 100% of such claims in the city for the year.

Medicaid payments in Evaluation and Management were also concentrated within a small subset of billing codes.

In comparing annual growth, Banner Elk’s Medicaid payments for this category climbed 274.5% from 2023 to 2024, compared with a 268.9% increase across all categories in the city in the same timeframe.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached about $871.7 billion in fiscal 2023. This accounted for around 18% of all national health expenditures, up sharply from approximately $613.5 billion in 2019, prior to the COVID-19 pandemic.

The data highlights a roughly 40% increase over a few years, driven mainly by growing enrollment and higher usage following the pandemic.

Federal budget changes under the Trump administration have included major proposals reducing Medicaid funding at the federal level and reshaping the program. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to trim federal Medicaid spending by over $1 trillion in the next 10 years and introduces measures such as work requirements and higher cost-sharing that could lower coverage and funds for certain beneficiaries. These reforms may increase financial strain on states while limiting future federal Medicaid support as the program continues to serve 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.