Providers participating in Medicaid in Sutherlin reported $394,217 in claims for Evaluation and Management services in 2024, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 263.8% jump from 2023, when claims filed for the same service totaled $108,364.
Medicaid operates as a state-administered, federally and state-funded public insurance program designed to cover low-income individuals, children, seniors, and people with disabilities, making it a significant component of the nation’s health care system.
Because Medicaid is funded by taxpayers, fluctuations in billing at the local level reflect how communities direct public health resources.
The Evaluation and Management category consists of services grouped according to care type and identified using primary HCPCS and CPT codes. This analysis placed each billing code into a single service group using specific code prefixes and number ranges, making it possible to analyze related services without overlap and maintain accurate rankings year over year.
While multiple Medicare service groups experienced spending growth, Evaluation and Management ranked highest in Sutherlin for total Medicaid spending in 2024.
Statewide in Oregon, Evaluation and Management also led all other categories by total Medicaid reimbursement in 2024.
Between 2020 and 2024, Medicaid spending for Evaluation and Management in Sutherlin climbed $373,253, or 1780.4%. At certain points, year-over-year payments accelerated, with significant increases noted for 2023 and 2022.
Although spending for Evaluation and Management services occurred citywide, the majority of claims were concentrated in a few ZIP codes. In 2024, ZIP code 97479 accounted for $394,217 in Medicaid payments in this group, making up 100% of such payments in Sutherlin that year.
A small set of billing codes represented most Medicaid claims related to Evaluation and Management services.
To compare, local Medicaid payments in Sutherlin for Evaluation and Management services increased by 263.8% from 2023 to 2024, while all Medicaid categories across the city had a combined 211.1% increase during the same period.
Centers for Medicare & Medicaid Services data show that state and federal Medicaid spending reached about $871.7 billion in fiscal year 2023, approximately 18% of all U.S. health expenditures, a sharp rise from $613.5 billion in 2019 before the COVID-19 pandemic.
This represents an increase of close to 40% in several years, largely attributable to greater enrollment and service utilization related to the pandemic period.
Federal policy changes made during the Trump administration have included proposals for reducing federal Medicaid contributions and adjusting program design. The “One Big Beautiful Bill Act,” enacted in 2025, is set to cut more than $1 trillion in federal support for Medicaid over 10 years and introduces measures such as work requirements and increased cost-sharing, raising the possibility of reduced coverage for some enrollees. These adjustments are projected to result in greater cost-sharing with states and may slow the growth of federal spending, though the program continues to support tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $20,964 | -70.4% |
| 2021 | $5,774 | -72.5% |
| 2023 | $108,364 | 1776.7% |
| 2024 | $394,217 | 263.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $394,217 | 98.1% |
| 2 | Pathology and Laboratory Procedures | $5,041 | 1.3% |
| 3 | Procedures / Professional Services | $2,123 | 0.5% |
| 4 | Medicine Services and Procedures | $296 | 0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99214 | Office o/p est mod 30 min | $200,425 | 78 |
| 99213 | Office o/p est low 20 min | $191,771 | 49 |
| 99203 | Office o/p new low 30 min | $1,462 | 1 |
| 99490 | Chrnc care mgmt staff 1st 20 | $558 | 1 |
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.