Lyons Falls Medicaid claims for Evaluation and Management reach $127,537 in 2024

Lyons Falls Medicaid providers invoiced $127,537 for services categorized as Evaluation and Management in 2024, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This figure reflects a 6% increase from 2023, when claims for the same service category totaled $120,288.

Medicaid serves as a publicly funded health insurance program managed by the states with support from both federal and state governments. The program offers coverage to low-income people, including families, seniors, children, and individuals with disabilities, making it one of the nation’s principal health care programs.

Because taxpayer contributions fund Medicaid, fluctuations in local billing indicate how public health care dollars are distributed within communities.

The “Evaluation and Management” group includes a range of Medicaid services outlined by the type of care offered, classified under established HCPCS and CPT code groups. For this report, each billing code was specifically tied to one service group using standardized prefixes and ranges to group related services accurately, while avoiding overlaps and maintaining precise rankings across different years.

Medicaid spending climbed in several service groups, but Evaluation and Management was the top category by total Medicaid payments in Lyons Falls in 2024.

Statewide, Evaluation and Management stood second among Medicaid payment categories in New York for 2024.

Across the five years preceding 2024, Medicaid payments connected to Evaluation and Management services in Lyons Falls surged by $120,376, or 1,681%. The largest year-over-year growth rates occurred in 2023 and 2022, underscoring periods of accelerated spending.

Though spending within the Evaluation and Management group extended throughout the city, the highest payments were localized within specific ZIP codes. In 2024, ZIP code 13368 reported $127,536 in Medicaid disbursements related to Evaluation and Management—accounting for 100% of such payments citywide that year.

Medicaid payments within the Evaluation and Management group were also concentrated among a small selection of specific billing codes.

For context, Evaluation and Management Medicaid payments climbed 6% from 2023 to 2024 in Lyons Falls, compared to an overall Medicaid claims category increase of 5.7% for the city during that interval.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid outlays collectively totaled about $871.7 billion in fiscal year 2023, about 18% of the nation’s total health spending—up from approximately $613.5 billion in 2019, prior to the COVID-19 pandemic.

This increase totals nearly 40% in only a few years, mainly attributable to growth in enrollment and greater service use during and after the pandemic.

Recent federal budget actions under the Trump administration included major initiatives to decrease federal Medicaid spending and alter program structure. For example, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to cut federal Medicaid funding by more than $1 trillion over 10 years. The law also implements policies like work requirements and higher cost-sharing, potentially reducing access and funding for some participants. These steps are set to push more Medicaid costs onto states and could curtail federal support, even as millions of Americans continue to rely on the program.

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.