Fanwood Medicaid billing for Evaluation and Management services rises 18.5% in 2024

Fanwood Medicaid providers submitted $14,257 in claims for Evaluation and Management services in 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents an 18.5% increase from 2023, when $12,028 in claims were filed for the same services.

Medicaid, a public health insurance program administered by the states and jointly funded by federal and state governments, covers eligible low-income individuals and families, seniors, children, and people with disabilities. It remains one of the nation’s largest health care programs.

As Medicaid is financed by tax dollars, local billing trends highlight how public health funds are distributed within a given community.

The “Evaluation and Management” group consists of Medicaid-billed services classified by care type using standardized HCPCS and CPT codes. This analysis groups each billing code into a single service category using consistent code prefixes and numeric ranges, which prevents double counting and maintains reliable service rankings over time.

Medicaid expenditures followed an overall upward trend in many categories. In 2024, Evaluation and Management was the third largest Medicaid category by total payments in Fanwood.

At the state level, Evaluation and Management also ranked third in New Jersey for Medicaid payments in 2024.

Medicaid spending related to Evaluation and Management services in Fanwood rose by $4,724, or 49.6%, over the five-year period ending in 2024. The rate of growth accelerated in specific years, with especially sharp year-over-year gains observed during 2021 and 2020.

Although spending on Evaluation and Management services occurred citywide, most Medicaid payments in 2024 were clustered in a small number of ZIP codes. In that year, ZIP code 07023 accounted for $14,256, making up 100% of the Medicaid payments for Evaluation and Management services recorded in Fanwood.

Within this category, the distribution of Medicaid funds was focused on just a small selection of individual billing codes.

Evaluation and Management Medicaid payments in Fanwood grew 18.5% between 2024 and 2023, compared to a 17.7% increase across all Medicaid service categories in the area over the same period.

According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached roughly $871.7 billion in the 2023 fiscal year, representing approximately 18% of all U.S. health care expenditures; this amount is a significant rise from $613.5 billion in 2019, prior to the onset of the COVID-19 pandemic.

This increase amounts to about 40% over several years, with most of the growth attributed to rising enrollment and increased service use during and after the pandemic.

Recent federal budget acts under the Trump administration have outlined broad changes to federal Medicaid support. The “One Big Beautiful Bill Act,” enacted in 2025, aims to reduce federal Medicaid spending by more than $1 trillion over the next decade, introducing policies such as work requirements and larger cost-sharing obligations that may shrink coverage and public funding for certain groups. Such measures are expected to shift costs toward state budgets and slow the future growth of federal Medicaid support while the program remains crucial for millions of Americans.

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.

This article’s information is based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original dataset can be accessed here.