Pulaski Medicaid providers billed $3,350,612 in 2024 for services in the Evaluation and Management category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents a 5.5% rise from 2023, when providers billed $3,175,946 for the same services.
Medicaid is a public health insurance program operated by states and funded jointly by federal and state governments. It provides coverage to low-income individuals and families, seniors, children, and people with disabilities, making it a major component of the U.S. health care system.
Because Medicaid is taxpayer-funded, fluctuations in local billing levels reflect how public health care funding is distributed throughout the community.
The Evaluation and Management category encompasses a set of Medicaid-billed services determined by the type of care, using standardized HCPCS and CPT code groupings. This analysis assigned each billing code to a single service group through consistent code prefixes and numeric ranges, helping to examine related services collectively and avoid double counting, thus preserving accurate rankings over time.
While Medicaid spending grew in several service categories, Evaluation and Management was Pulaski’s highest by total Medicaid payments in 2024.
Statewide in New York, Evaluation and Management ranked second among all Medicaid payment categories for 2024.
From 2020 to 2024, Medicaid payments associated with Evaluation and Management in Pulaski rose by $785,124, or 30.6%. The pace of growth increased during certain periods, including notable year-over-year gains in 2023 and 2020.
Though Evaluation and Management services were provided across the city, Medicaid payments concentrated primarily in a small number of ZIP codes. In 2024, ZIP code 13142 accounted for $3,350,611, making up 100% of Pulaski’s Medicaid payments for this category during the year.
Payments within the Evaluation and Management category were similarly focused among a select group of individual billing codes.
Compared with 2023, Pulaski’s Medicaid payments for Evaluation and Management grew 5.5%, while overall Medicaid claim categories in the city rose by 2.2% during the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending reached about $871.7 billion during the 2023 fiscal year—the equivalent of approximately 18% of national health expenditures—up substantially from around $613.5 billion in 2019, before the COVID-19 pandemic.
This marks a roughly 40% increase over just a few years, largely attributed to expanded enrollment and greater utilization during and following the pandemic.
Recent federal budget measures under the Trump administration have included major proposals to decrease federal Medicaid funding and modify the structure of the program. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid spending by over $1 trillion over 10 years and implements policies such as work requirements and higher cost-sharing that may decrease coverage and funding for some recipients. These provisions are anticipated to shift more financial responsibility to states and may constrain federal support for Medicaid’s expansion, even as the program continues to enroll tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $2,565,488 | 5.2% |
| 2021 | $2,666,381 | 3.9% |
| 2022 | $2,657,221 | -0.3% |
| 2023 | $3,175,945 | 19.5% |
| 2024 | $3,350,611 | 5.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $3,350,611 | 78.7% |
| 2 | Medicine Services and Procedures | $490,530 | 11.5% |
| 3 | Ambulance and Other Transport Services and Supplies | $224,082 | 5.3% |
| 4 | Pathology and Laboratory Procedures | $108,320 | 2.5% |
| 5 | Dental Services | $80,802 | 1.9% |
| 6 | Radiology Procedures | $1,586 | <0.1% |
| 7 | Procedures / Professional Services | $133 | <0.1% |
| 7 | Surgery | $133 | <0.1% |
| 9 | Drugs Administered Other than Oral Method | $6 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $1,544,758 | 197 |
| 99214 | Office o/p est mod 30 min | $1,190,349 | 173 |
| 99393 | Prev visit est age 5-11 | $77,172 | 16 |
| 99392 | Prev visit est age 1-4 | $72,732 | 18 |
| 99215 | Office o/p est hi 40 min | $70,687 | 21 |
| 99203 | Office o/p new low 30 min | $64,895 | 29 |
| 99391 | Per pm reeval est pat infant | $58,850 | 16 |
| 99395 | Prev visit est age 18-39 | $58,785 | 12 |
| 99394 | Prev visit est age 12-17 | $52,266 | 10 |
| 99396 | Prev visit est age 40-64 | $50,247 | 10 |
| 99212 | Office o/p est sf 10 min | $42,263 | 16 |
| 99442 | $20,308 | 9 | |
| 99051 | Med serv eve/wkend/holiday | $14,328 | 26 |
| 99204 | Office o/p new mod 45 min | $12,138 | 5 |
| 99211 | Off/op est may x req phy/qhp | $10,683 | 4 |
| 99443 | $8,827 | 7 | |
| 99173 | Visual acuity screen | $565 | 21 |
| 99177 | Ocular instrumnt screen bil | $408 | 9 |
| 99406 | Behav chng smoking 3-10 min | $341 | 10 |
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.
