Astoria Medicaid providers reported billing $4,191,273 under the Evaluation and Management category in 2024, the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents an 8.6% increase from 2023, when billing for the same category totaled $3,860,616.
Medicaid, a public health insurance initiative managed by the states and financed by both federal and state governments, covers low-income residents, families, seniors, children, and individuals with disabilities, forming one of the country’s major health care programs.
Since Medicaid is funded by taxpayers, fluctuations in community billing help show how public health resources are distributed locally.
The Evaluation and Management category includes various Medicaid services grouped by care type and based on standardized HCPCS and CPT codes. Each code in this analysis was assigned to just one service category, using consistent numeric ranges and prefixes to allow aggregated analysis and consistent historical ranking.
Although Medicaid funding grew across several service divisions, Evaluation and Management was Astoria’s top-ranked category in 2024 for total Medicaid payments.
Statewide in Oregon, Evaluation and Management also received the largest share of Medicaid funding in 2024.
From 2019 through 2024, Astoria saw Medicaid payments for the Evaluation and Management category climb by $1,419,060—or 51.2%. Periods of accelerated growth included significant annual increases in both 2022 and 2023.
While spending under the Evaluation and Management category occurred citywide, Medicaid payments were focused in a small number of ZIP codes. During 2024, ZIP code 97103 accounted for all Medicaid payments for the Evaluation and Management category in Astoria, totaling $4,191,272 and representing 100% of payments tied to the category that year.
Within this service group, only a few individual billing codes represented the bulk of Medicaid spending.
Astoria’s Medicaid payments in the Evaluation and Management category rose by 8.6% from 2023 to 2024, while overall Medicaid payments citywide grew 7.4% across all claim categories during the same time span.
Centers for Medicare & Medicaid Services data report joint federal and state Medicaid expenditures reaching about $871.7 billion for fiscal 2023—nearly 18% of all U.S. health costs—rising sharply from roughly $613.5 billion in 2019, before the pandemic.
This change marks about 40% growth over several years, influenced by increased enrollment and greater service utilization linked to pandemic effects.
Recent federal budget laws passed under the Trump administration contain key measures to trim federal Medicaid spending and alter the program’s design. The “One Big Beautiful Bill Act,” approved in 2025, is expected to reduce federal Medicaid expenditures by over $1 trillion during the next decade, introducing work requirements and higher cost-sharing that may restrict coverage and funding for certain groups. As a result, more costs may shift to states, curtailing the growth of federal support even while Medicaid remains a cornerstone for tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $2,772,213 | -12.5% |
| 2021 | $2,685,439 | -3.1% |
| 2022 | $3,428,308 | 27.7% |
| 2023 | $3,860,616 | 12.6% |
| 2024 | $4,191,272 | 8.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $4,191,272 | 75.7% |
| 2 | Medicine Services and Procedures | $849,284 | 15.3% |
| 3 | Pathology and Laboratory Procedures | $229,526 | 4.1% |
| 4 | Durable Medical Equipment | $72,873 | 1.3% |
| 5 | Medical And Surgical Supplies | $69,555 | 1.3% |
| 6 | Radiology Procedures | $39,530 | 0.7% |
| 7 | Surgery | $27,165 | 0.5% |
| 8 | National Codes Established for State Medicaid Agencies | $24,661 | 0.4% |
| 9 | Alcohol and Drug Abuse Treatment | $15,187 | 0.3% |
| 10 | Dental Services | $6,864 | 0.1% |
| 11 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $4,043 | 0.1% |
| 12 | Drugs Administered Other than Oral Method | $4,014 | 0.1% |
| 13 | Temporary Codes | $2,888 | 0.1% |
| 14 | Procedures / Professional Services | $38 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99284 | Emergency dept visit mod mdm | $1,642,641 | 150 |
| 99285 | Emergency dept visit hi mdm | $983,064 | 60 |
| 99283 | Emergency dept visit low mdm | $801,190 | 91 |
| 99213 | Office o/p est low 20 min | $372,531 | 300 |
| 99214 | Office o/p est mod 30 min | $212,972 | 213 |
| 99392 | Prev visit est age 1-4 | $45,755 | 30 |
| 99215 | Office o/p est hi 40 min | $35,066 | 19 |
| 99391 | Per pm reeval est pat infant | $29,784 | 22 |
| 99393 | Prev visit est age 5-11 | $20,214 | 12 |
| 99203 | Office o/p new low 30 min | $16,769 | 14 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $11,309 | 10 |
| 99282 | Emergency dept visit sf mdm | $7,158 | 2 |
| 99239 | Hosp ip/obs dschrg mgmt >30 | $6,462 | 7 |
| 99202 | Office o/p new sf 15 min | $3,570 | 3 |
| 99394 | Prev visit est age 12-17 | $1,620 | 1 |
| 99222 | 1st hosp ip/obs moderate 55 | $719 | 1 |
| 99212 | Office o/p est sf 10 min | $224 | 8 |
| 99204 | Office o/p new mod 45 min | $215 | 8 |
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.
