Wilsonville Medicaid spending on Evaluation and Management services reaches $49,401 in 2024

Wilsonville Medicaid providers submitted $49,401 in claims for services in the Evaluation and Management category in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represented a 63.1% increase from the 2023 total of $30,283 claimed for the same service type.

Medicaid, operated by individual states and jointly funded by federal and state governments, provides health insurance coverage for low-income families, children, seniors, and people with disabilities. It is among the largest components of the U.S. health care system, as explained by the Commonwealth Fund.

Shifts in how Medicaid dollars are billed at the local level reveal how public health expenditures are allocated within communities that rely on taxpayer funding.

The “Evaluation and Management” grouping covers a range of Medicaid-reimbursed services identified through standardized HCPCS and CPT codes. For this analysis, every billing code was categorized into a service group using regular code prefixes and number ranges to prevent overlap and double counting, ensuring accuracy in service category trends and rankings.

Among all Medicaid service groupings in 2024, Evaluation and Management ranked fourth for overall Medicaid payments in Wilsonville.

Statewide, however, Evaluation and Management was the leading group by total Medicaid payment volume in Oregon during 2024.

Looking at the five years before 2024, Medicaid payments for Evaluation and Management services in Wilsonville grew by $43,248, or 702.9%. There were substantial year-on-year increases during certain periods, notably in both 2023 and 2022.

Although spending for Evaluation and Management care stretched throughout the city, the majority was concentrated in a single ZIP code. In 2024, ZIP code 97070 received the full $49,401 for such claims. This top ZIP accounted for all Medicaid payments in this category for Wilsonville in that year.

Additionally, billing was concentrated within a handful of individual HCPCS codes under the Evaluation and Management category.

Between 2024 and 2023, Evaluation and Management Medicaid payments in Wilsonville rose by 63.1%, whereas the increase across all Medicaid claim categories in the city stood at 12.3% for the same timeframe.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled approximately $871.7 billion in fiscal year 2023, accounting for around 18% of the nation’s total health spending, up significantly from $613.5 billion in 2019, prior to the COVID-19 pandemic.

This increase amounts to a nearly 40% jump over several years, with growth largely caused by increased enrollment and greater use of services during and after the pandemic years.

Recent national budget legislation passed during the Trump administration introduced large-scale proposals to decrease federal Medicaid support and rework the program’s structure. One example is the “One Big Beautiful Bill Act,” enacted in 2025, which is expected to trim more than $1 trillion in federal Medicaid spending over the next 10 years and includes new work requirements and increased cost-sharing. Those changes could reduce coverage and funding for some users, shift costs to states and limit federal Medicaid growth, while the program remains essential to tens of 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.

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.