Crossville Medicaid providers submitted $2,970,567 in claims for Evaluation and Management services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. That represents a 1% uptick over 2023, when billings for these services totaled $2,940,899.
Medicaid is a state-administered public health insurance program jointly funded by federal and state governments. It serves low-income individuals and families, seniors, children, and people with disabilities, making it a core component of the national health care system.
Because taxpayer dollars fund Medicaid, shifts in local billing levels indicate how health care funds are distributed within the community.
The “Evaluation and Management” group includes Medicaid-billed services determined by the type of care, defined by specific HCPCS and CPT code clusters. For this report, service categories were assigned based on uniform code prefixes and numerical ranges to keep related services together, minimize duplicates, and maintain accurate year-to-year rankings.
Spending in the Evaluation and Management category was the second-largest Medicaid payment category in Crossville in 2024, following growth across several service types that year.
Statewide, Evaluation and Management was also the second-largest Medicaid payment category in Tennessee during 2024.
Between 2019 and 2024, Crossville saw Evaluation and Management Medicaid payments rise by $1,033,499, an increase of 53.4%. Notable gains occurred in both 2022 and 2021, when year-over-year growth accelerated.
While care in this category was delivered across Crossville, most Medicaid payments were concentrated among specific ZIP codes. In 2024, ZIP code 38555 accounted for $2,817,651 and 38571 for $152,915 in Evaluation and Management payments, with these two ZIP codes comprising 100% of the city’s total in this category for the year.
Within the category, payments were further focused among a relatively small number of individual billing codes.
By comparison, the 1% increase for Evaluation and Management between 2023 and 2024 in Crossville came alongside a 24.6% change in total Medicaid payments across all claim categories in the city over the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state spending for Medicaid reached about $871.7 billion in fiscal 2023—roughly 18% of total national health expenditures—up from an estimated $613.5 billion in 2019, prior to the COVID-19 pandemic.
This amounts to a roughly 40% increase in just a few years, primarily driven by higher enrollment and service use during and following the pandemic.
Federal budget legislation enacted during the Trump administration brought significant proposals to cut federal Medicaid funding and revise program structure. For example, the “One Big Beautiful Bill Act,” signed into law in 2025, is expected to reduce federal Medicaid funding by over $1 trillion over the next decade and includes measures such as work requirements and higher cost-sharing that could reduce coverage for some beneficiaries. These changes are likely to place more fiscal responsibility on states and restrict federal Medicaid growth, even as the program serves tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,937,068 | -19.2% |
| 2021 | $2,247,852 | 16% |
| 2022 | $2,673,314 | 18.9% |
| 2023 | $2,940,899 | 10% |
| 2024 | $2,970,567 | 1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $5,486,690 | 46.2% |
| 2 | Evaluation and Management | $2,970,567 | 25% |
| 3 | Medicine Services and Procedures | $1,820,798 | 15.3% |
| 4 | Surgery | $507,011 | 4.3% |
| 5 | Ambulance and Other Transport Services and Supplies | $403,674 | 3.4% |
| 6 | Radiology Procedures | $236,911 | 2% |
| 7 | Pathology and Laboratory Procedures | $149,855 | 1.3% |
| 8 | Durable Medical Equipment | $121,971 | 1% |
| 9 | Procedures / Professional Services | $62,589 | 0.5% |
| 10 | Vision Services | $51,983 | 0.4% |
| 11 | Medical And Surgical Supplies | $43,287 | 0.4% |
| 12 | Chemotherapy Drugs | $10,151 | 0.1% |
| 13 | Anesthesia | $3,817 | <0.1% |
| 14 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $2,002 | <0.1% |
| 15 | Drugs Administered Other than Oral Method | $948 | <0.1% |
| 16 | Alcohol and Drug Abuse Treatment | $504 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| 17 | Dental Services | $0 | <0.1% |
| 17 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $807,160 | 277 |
| 99214 | Office o/p est mod 30 min | $506,426 | 278 |
| 99284 | Emergency dept visit mod mdm | $377,678 | 52 |
| 99283 | Emergency dept visit low mdm | $261,682 | 55 |
| 99285 | Emergency dept visit hi mdm | $175,116 | 33 |
| 99392 | Prev visit est age 1-4 | $146,672 | 79 |
| 98941 | Chiropract manj 3-4 regions | $118,123 | 62 |
| 99391 | Per pm reeval est pat infant | $111,317 | 63 |
| 99393 | Prev visit est age 5-11 | $96,202 | 63 |
| 99212 | Office o/p est sf 10 min | $61,154 | 70 |
| 99282 | Emergency dept visit sf mdm | $55,405 | 26 |
| 99204 | Office o/p new mod 45 min | $54,518 | 39 |
| 99394 | Prev visit est age 12-17 | $42,336 | 29 |
| 99203 | Office o/p new low 30 min | $33,437 | 32 |
| 99395 | Prev visit est age 18-39 | $32,825 | 16 |
| 99244 | Off/op cnsltj new/est mod 40 | $17,338 | 7 |
| 99490 | Chrnc care mgmt staff 1st 20 | $13,208 | 10 |
| 99401 | Prev med cnsl indiv apprx 15 | $12,785 | 18 |
| 99215 | Office o/p est hi 40 min | $12,454 | 11 |
| 99463 | Same day nb discharge | $8,833 | 8 |
Note: HCPCS codes are provided for context. Totals and rankings in this article are calculated based on the standardized service groupings, not individual code usage.
Data cited in this article was sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original data is available here.
