In 2024, Medicaid providers in Plainfield recorded $2,287,087 in claims for Evaluation and Management services, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents an increase of 13.8% compared with 2023, when $2,009,890 was billed for the category.
Medicaid functions as a public health insurance program administered at the state level and funded in partnership by federal and state governments. It provides coverage for low-income people, seniors, children, and individuals with disabilities, making it a key component of the U.S. health care system.
Because Medicaid payments derive from taxpayer funding, adjustments in local billing reflect how public health care dollars are distributed within the community.
The “Evaluation and Management” classification refers to a specific set of Medicaid services, defined by the type of care using standardized HCPCS and CPT code groupings. For this report, each billing code was assigned to one service category based on consistent code prefixes and number ranges. This enabled analysts to group related services together while preventing duplicate counts and ensuring accurate tracking over time.
While Medicaid spending grew in several categories, Evaluation and Management led all others in Plainfield by total payment amount in 2024.
Statewide in New Jersey, Evaluation and Management placed third among all Medicaid service categories for total payments in 2024.
From 2019 through 2024, Medicaid payments in Plainfield for Evaluation and Management increased by $607,245 or 36.1%. Certain years, such as 2021 and 2022, saw pronounced annual growth in spending for the category.
Though payments covered providers across the city, most spending was reported in just two ZIP codes. In 2024, the highest Medicaid payments in Evaluation and Management were in 07060 at $1,862,809 and 07063 at $424,277. These two ZIP codes together represented all Medicaid claims for the category in Plainfield for the year.
Within this category, a small set of individual billing codes accounted for the majority of Medicaid service payments.
Between 2024 and 2023, Medicaid claims for Evaluation and Management in Plainfield increased by 13.8%, significantly outpacing the 1.4% overall rise across all Medicaid claim categories in the city during that interval.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid expenditures reached roughly $871.7 billion during fiscal 2023, making up about 18% of total U.S. health spending—an increase from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This rise represents an approximate 40% increase over several years, largely driven by expanded enrollment and greater service use during and after the pandemic.
Recent federal budget actions during the Trump administration included proposals reducing federal Medicaid support and restructuring the program. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to decrease federal Medicaid funding by over $1 trillion over the next decade and introduces provisions such as work requirements and increased cost-sharing, which may reduce funding and coverage for certain beneficiaries. These changes are anticipated to require states to bear more program costs and could limit further federal funding increases, even as Medicaid continues to cover tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,679,841 | -25.2% |
| 2021 | $2,259,775 | 34.5% |
| 2022 | $2,392,361 | 5.9% |
| 2023 | $2,009,889 | -16% |
| 2024 | $2,287,086 | 13.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $2,287,086 | 33.7% |
| 2 | Procedures / Professional Services | $1,778,287 | 26.2% |
| 3 | National Codes Established for State Medicaid Agencies | $1,158,568 | 17.1% |
| 4 | Medicine Services and Procedures | $969,133 | 14.3% |
| 5 | Alcohol and Drug Abuse Treatment | $476,419 | 7% |
| 6 | Durable Medical Equipment | $40,891 | 0.6% |
| 7 | Surgery | $25,906 | 0.4% |
| 8 | Pathology and Laboratory Procedures | $19,461 | 0.3% |
| 9 | Medical And Surgical Supplies | $16,208 | 0.2% |
| 10 | Dental Services | $9,586 | 0.1% |
| 11 | Drugs Administered Other than Oral Method | $463 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $971,929 | 174 |
| 99361 | $379,172 | 5 | |
| 99214 | Office o/p est mod 30 min | $256,397 | 85 |
| 99284 | Emergency dept visit mod mdm | $190,506 | 81 |
| 99393 | Prev visit est age 5-11 | $97,295 | 37 |
| 99392 | Prev visit est age 1-4 | $93,529 | 38 |
| 99212 | Office o/p est sf 10 min | $78,998 | 62 |
| 99394 | Prev visit est age 12-17 | $61,093 | 31 |
| 99391 | Per pm reeval est pat infant | $45,342 | 41 |
| 99283 | Emergency dept visit low mdm | $44,578 | 49 |
| 99211 | Off/op est may x req phy/qhp | $23,246 | 12 |
| 99285 | Emergency dept visit hi mdm | $15,754 | 15 |
| 99203 | Office o/p new low 30 min | $11,303 | 10 |
| 99188 | App topical fluoride varnish | $6,715 | 11 |
| 99395 | Prev visit est age 18-39 | $4,271 | 3 |
| 99173 | Visual acuity screen | $2,553 | 60 |
| 99401 | Prev med cnsl indiv apprx 15 | $2,015 | 7 |
| 99204 | Office o/p new mod 45 min | $1,131 | 1 |
| 99308 | Sbsq nf care low mdm 20 | $612 | 4 |
| 99309 | Sbsq nf care moderate mdm 30 | $494 | 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.
