In 2024, Medicaid providers in Orem submitted $2,296,776 in claims for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total reflects an increase of 228.1% from the previous year, when these claims reached $700,109.
Medicaid, a state-run health insurance program funded cooperatively by the federal and state governments, serves low-income families and individuals, people with disabilities, children, and seniors. This makes it one of the largest parts of the U.S. health care system.
Since Medicaid payments come from public funds, local billing changes provide insight into how health care dollars are distributed in each community.
The “Evaluation and Management” category includes Medicaid-billed services based on specific care types defined by standardized HCPCS and CPT code groupings. For this study, each code was matched to a single service category through uniform prefixes and number ranges, allowing grouped services to be tracked without double counting or misranking across years.
Medicaid spending increased in several service categories, with Evaluation and Management ranking third in Orem by total payments in 2024.
Evaluation and Management also ranked third among all Medicaid payment categories in Utah for the year.
Looking at the five-year period leading up to 2024, Orem experienced a $1,980,809 rise in Medicaid payments tied to Evaluation and Management services, representing a 626.9% increase. Certain years, including 2021 and 2022, saw especially rapid growth in spending.
Payment distribution for care in the Evaluation and Management category spanned the city, but most funds went to a small number of ZIP codes. In 2024, ZIP code 84057 led with $2,028,628, followed by 84097 with $266,438, and 84058 with $1,708. Combined, these 3 ZIP codes accounted for all Medicaid Evaluation and Management payments in Orem that year.
Additionally, within the Evaluation and Management category, a relatively small subset of billing codes accounted for the bulk of Medicaid payments.
By comparison, from 2023 to 2024, Medicaid payments for Evaluation and Management in Orem rose 228.1%, while total Medicaid claims across all categories in the city increased by just 4.5% over the same period.
According to the Centers for Medicare & Medicaid Services, in 2023, combined federal and state Medicaid spending totaled nearly $871.7 billion and made up about 18% of total national health expenditures. This represents a sharp increase from roughly $613.5 billion in 2019, before the pandemic.
This 40% growth in just a few years is largely tied to increased enrollment and higher health care usage during and after the COVID-19 pandemic.
Recent federal legislative changes under the Trump administration include major proposals to reduce Medicaid’s federal funding and change its structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to trim more than $1 trillion in federal Medicaid spending over 10 years, while introducing policies such as work requirements and higher cost-sharing that may reduce coverage and benefits for some enrollees. These measures are projected to transfer more costs to the states and restrict federal Medicaid growth, as the program continues to cover millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $315,966 | -20.1% |
| 2021 | $781,246 | 147.3% |
| 2022 | $766,418 | -1.9% |
| 2023 | $700,108 | -8.7% |
| 2024 | $2,296,775 | 228.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Alcohol and Drug Abuse Treatment | $2,485,764 | 23.5% |
| 2 | National Codes Established for State Medicaid Agencies | $2,476,538 | 23.4% |
| 3 | Evaluation and Management | $2,296,775 | 21.7% |
| 4 | Medicine Services and Procedures | $1,852,829 | 17.5% |
| 5 | Pathology and Laboratory Procedures | $656,056 | 6.2% |
| 6 | Ambulance and Other Transport Services and Supplies | $382,547 | 3.6% |
| 7 | Durable Medical Equipment | $175,812 | 1.7% |
| 8 | Dental Services | $113,404 | 1.1% |
| 9 | Surgery | $78,074 | 0.7% |
| 10 | Anesthesia | $33,847 | 0.3% |
| 11 | Medical And Surgical Supplies | $24,431 | 0.2% |
| 12 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $5,015 | <0.1% |
| 13 | Procedures / Professional Services | $87 | <0.1% |
| 14 | Radiology Procedures | $72 | <0.1% |
| 15 | Temporary Codes | $1 | <0.1% |
| 16 | Drugs Administered Other than Oral Method | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99202 | Office o/p new sf 15 min | $1,455,624 | 116 |
| 99215 | Office o/p est hi 40 min | $163,393 | 23 |
| 99214 | Office o/p est mod 30 min | $147,514 | 62 |
| 99213 | Office o/p est low 20 min | $128,545 | 71 |
| 99417 | Prolng op e/m each 15 min | $93,650 | 11 |
| 99284 | Emergency dept visit mod mdm | $51,111 | 29 |
| 99231 | Sbsq hosp ip/obs sf/low 25 | $49,651 | 9 |
| 99283 | Emergency dept visit low mdm | $44,635 | 27 |
| 99233 | Sbsq hosp ip/obs high 50 | $44,394 | 9 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $40,159 | 11 |
| 99223 | 1st hosp ip/obs high 75 | $24,441 | 11 |
| 99212 | Office o/p est sf 10 min | $20,708 | 12 |
| 99203 | Office o/p new low 30 min | $19,044 | 4 |
| 99391 | Per pm reeval est pat infant | $6,673 | 11 |
| 99222 | 1st hosp ip/obs moderate 55 | $5,037 | 5 |
| 99392 | Prev visit est age 1-4 | $1,424 | 5 |
| 99393 | Prev visit est age 5-11 | $464 | 1 |
| 99211 | Off/op est may x req phy/qhp | $301 | 1 |
| 99177 | Ocular instrumnt screen bil | $0 | 2 |
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.
