Mequon Medicaid Evaluation and Management payments climb to $199,684 in 2024

Providers in Mequon received $199,684 from Medicaid for services listed under the Evaluation and Management group in 2024, according to figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. That amount increased by 12.6% over 2023, when $177,400 was billed for the same services.

Medicaid, a publicly funded health insurance initiative operated at the state level and supported with both federal and state resources, provides coverage for low-income groups, the elderly, children, and people with disabilities. This makes it a key component of the nation’s health care landscape.

Because taxpayer dollars fund Medicaid, shifts in how services are billed locally reflect how public health care money circulates within a community.

The “Evaluation and Management” category groups Medicaid-billed services by care type using consistent HCPCS and CPT code frameworks. For this analysis, each billing code fits one service group defined by set code segments, allowing related medical services to be compared accurately without risk of double counting, and resulting in precise rankings over time.

While Medicaid spending went up across several groups, Evaluation and Management placed third in Mequon for overall Medicaid outlays in 2024.

Statewide, Evaluation and Management was the second-largest category by Medicaid payments in Wisconsin in 2024.

Looking at the five years ending in 2024, Medicaid payments in Evaluation and Management for Mequon rose by $130,852, representing a 39.6% increase. Some periods experienced steeper year-over-year rises, particularly in 2021 and 2022.

Spending for Evaluation and Management services was spread throughout Mequon but mostly centralized in a few ZIP codes. ZIP code 53092 made up $198,876 of 2024 Medicaid payments for the category, and 53097 made up $807. Together, these top two accounted for all Medicaid spending linked to Evaluation and Management in Mequon that year.

Within the Evaluation and Management group, a small set of specific billing codes concentrated the majority of Medicaid payments.

For context, the 12.6% increase for Evaluation and Management services in Mequon from 2023 to 2024 compared to a 10.1% increase across all Medicaid claim types in the city over the same interval.

The Centers for Medicare & Medicaid Services reported that total federal and state Medicaid spending reached approximately $871.7 billion in fiscal year 2023. This comprised about 18% of overall U.S. health expenditures—a significant increase from roughly $613.5 billion before the COVID-19 pandemic in 2019.

This change signals a growth of around 40% in only a few years, mainly due to expanded enrollment and greater use of health services during and after the pandemic.

Recent federal budget measures during the Trump administration have introduced major proposals to reduce federal Medicaid funding and reshape the program. As an example, the “One Big Beautiful Bill Act,” enacted in 2025, is forecasted to cut over $1 trillion from federal Medicaid support over the next decade. The law also brings in policies like added work requirements and increased cost-sharing, which could decrease both Medicaid coverage and funding for some individuals. This is expected to place extra cost burdens on states and limit future growth in federal Medicaid funding, despite the program continuing to help millions of Americans.

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.