In 2024, Medicaid providers in Spearfish billed a total of $756,003 for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 44.8% increase from 2023, when providers filed $522,055 in claims under this category.
Medicaid is a public health insurance program administered by the states and funded by both federal and state governments. It provides coverage for low-income individuals and families, older adults, children, and people with disabilities, making it one of the largest components of the U.S. health care system.
With Medicaid payments sourced from taxpayers, fluctuations in local billing levels reflect how health care funding is distributed in a given area.
The “Evaluation and Management” group comprises Medicaid-billed services classified by the nature of care delivered, based on standard HCPCS and CPT codes. For this report, each billing code was mapped to a single service type through consistent code prefixes and number ranges, ensuring that service groupings remain accurate and avoiding double counting over time.
Although Medicaid outlays rose across multiple categories, Evaluation and Management ranked as the second-highest category in Spearfish by total Medicaid payments in 2024.
Statewide, Evaluation and Management also held the second position in South Dakota for total Medicaid payments in 2024.
During the five-year span leading into 2024, Medicaid payments related to Evaluation and Management in Spearfish grew by $347,409, an 85% increase. Growth rates accelerated in select years, with prominent annual gains in 2021 and 2022.
While overall spending in the Evaluation and Management category was dispersed throughout Spearfish, most payments were concentrated within a few ZIP codes. In 2024, ZIP code 57783 recorded $756,003 in related Medicaid payments, making up 100% of the total for this service group in the city.
Within the category itself, most Medicaid payments came from a small subset of specific billing codes.
To compare, Medicaid payments for Evaluation and Management in Spearfish rose 44.8% between 2023 and 2024, while overall Medicaid billing for all categories in the area increased by 11.8% over the same timeframe.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid spending reached about $871.7 billion for fiscal year 2023. This made up roughly 18% of the country’s total health expenditures, a sharp increase from around $613.5 billion in 2019, before the COVID-19 pandemic.
This jump amounts to a roughly 40% increase in just a few years, mainly due to greater enrollment and higher health care usage during and after the pandemic period.
Recent federal budget packages under the Trump administration have featured major proposals aimed at reducing federal Medicaid contributions and restructuring the program. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to trim more than $1 trillion in federal Medicaid spending over the next ten years while adding measures such as work requirements and increased cost-sharing, changes that could affect coverage and spending for some enrollees. These policies are projected to shift additional costs to states and restrict federal Medicaid funding growth, though the program continues to serve tens of millions of people in the U.S.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $408,594 | -30.1% |
| 2021 | $575,039 | 40.7% |
| 2022 | $573,739 | -0.2% |
| 2023 | $522,054 | -9% |
| 2024 | $756,003 | 44.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $12,201,797 | 86.5% |
| 2 | Evaluation and Management | $756,003 | 5.4% |
| 3 | Medicine Services and Procedures | $467,123 | 3.3% |
| 4 | Administrative, Miscellaneous and Investigational | $174,686 | 1.2% |
| 5 | Ambulance and Other Transport Services and Supplies | $113,487 | 0.8% |
| 6 | Durable Medical Equipment | $89,147 | 0.6% |
| 7 | Temporary National Codes (Non-Medicare) | $77,792 | 0.6% |
| 8 | Procedures / Professional Services | $47,119 | 0.3% |
| 9 | Pathology and Laboratory Procedures | $36,568 | 0.3% |
| 10 | Drugs Administered Other than Oral Method | $35,753 | 0.3% |
| 11 | Radiology Procedures | $33,236 | 0.2% |
| 12 | Surgery | $26,129 | 0.2% |
| 13 | Vision Services | $23,962 | 0.2% |
| 14 | Dental Services | $9,367 | 0.1% |
| 15 | Anesthesia | $3,862 | <0.1% |
| 16 | Medical And Surgical Supplies | $3,480 | <0.1% |
| 17 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $474 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $235,314 | 44 |
| 99214 | Office o/p est mod 30 min | $182,774 | 43 |
| 98941 | Chiropract manj 3-4 regions | $73,878 | 34 |
| 99203 | Office o/p new low 30 min | $48,942 | 28 |
| 99283 | Emergency dept visit low mdm | $42,770 | 14 |
| 99284 | Emergency dept visit mod mdm | $40,923 | 12 |
| 99391 | Per pm reeval est pat infant | $36,351 | 14 |
| 99392 | Prev visit est age 1-4 | $26,789 | 12 |
| 99212 | Office o/p est sf 10 min | $16,400 | 22 |
| 99204 | Office o/p new mod 45 min | $13,074 | 8 |
| 99393 | Prev visit est age 5-11 | $13,061 | 8 |
| 99285 | Emergency dept visit hi mdm | $11,161 | 7 |
| 99215 | Office o/p est hi 40 min | $9,193 | 8 |
| 99282 | Emergency dept visit sf mdm | $3,685 | 6 |
| 99394 | Prev visit est age 12-17 | $1,292 | 1 |
| 98940 | Chiropract manj 1-2 regions | $386 | 1 |
Note: HCPCS codes are provided for context within the category. All category totals and rankings referenced here are based on standardized groupings rather than individual billing codes.
Figures in this article are drawn from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The underlying data can be accessed here.
