Darlington Medicaid Evaluation and Management payments rise 110% to $995 in 2024

In 2024, Medicaid providers in Darlington billed a total of $995 for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. That figure represents a 110.4% jump over 2023, when claims for this service category totaled $473.

Medicaid, a state-operated and jointly state-federally-funded public insurance program, offers coverage to seniors, children, low-income individuals and families, and people with disabilities, making it a major component of the nation’s health care system.

Since Medicaid dollars originate from taxpayers, changes in billing levels can reflect how a community’s public health care resources are spent.

The Evaluation and Management service group includes Medicaid-billed services categorized by type of care, based on designated HCPCS and CPT code groups. For this report, service codes were assigned to categories consistently using code prefixes and ranges to group related services for more accurate long-term comparisons and ranking.

Spending in various Medicaid service categories rose, but Evaluation and Management led all categories in Darlington by total Medicaid payments for 2024.

Statewide in Pennsylvania, Evaluation and Management ranked fourth in total Medicaid spending for 2024.

Over the five-year period prior to 2024, Darlington’s Medicaid payments for Evaluation and Management rose by $995, reflecting 0% growth. Certain years saw sharper increases, particularly in 2023 and 2022.

Although Medicaid spending on Evaluation and Management was spread across Darlington, payments were mainly concentrated in a small set of ZIP codes. In 2024, ZIP code 16115 recorded $994 in Medicaid payments—accounting for all payments made in this category in Darlington that year.

Within the broader Evaluation and Management category, only a small number of individual billing codes made up the majority of Medicaid payments.

For reference, Medicaid payments for Evaluation and Management services in Darlington grew by 110.4% between 2024 and 2023, while total citywide Medicaid claims increased 110.1% during the same period across all service types.

According to the Centers for Medicare & Medicaid Services, joint federal and state Medicaid expenditures were about $871.7 billion in fiscal year 2023, making up roughly 18% of national health spending—a sharp rise from $613.5 billion in 2019, prior to the COVID-19 pandemic.

This growth, approximately 40% in only a few years, has been attributed mainly to expanded Medicaid enrollment and increased utilization during and after the pandemic period.

Recent federal budget changes under the Trump administration have brought about major suggestions for Medicaid funding reductions and program restructuring. The “One Big Beautiful Bill Act,” signed in 2025, is expected to reduce federal Medicaid spending by over $1 trillion in the coming decade, also putting in place policies such as work requirements and higher cost sharing. These measures may reduce coverage for some people and shift a greater financial burden to states, restricting federal support even as the program remains vital to millions.

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.