In 2024, Medicaid providers in Reston billed $2,693,585 for services grouped under Evaluation and Management, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 2.6% rise compared with 2023, when $2,624,837 was billed for these services.
Medicaid, a public insurance program overseen by the states and funded by both federal and state sources, provides coverage for low-income individuals and families, seniors, children, and those with disabilities, making it a key component of the U.S. health care landscape.
With Medicaid revenue sourced from taxpayers, local billing levels reflect the distribution of public health care funding in the community.
The “Evaluation and Management” category is a collection of Medicaid-billed procedures distinguished by the nature of the care provided and organized by standard HCPCS and CPT codes. Each billing code in this report was sorted into a single service category using consistent prefixes and numeric groupings, to enable analysis by service type without duplication and to maintain consistent rankings over time.
Among service categories, Evaluation and Management represented the highest total Medicaid payments in Reston in 2024.
Statewide in Virginia, Evaluation and Management ranked as the third largest category in total Medicaid payments for the year.
During the five-year span leading up to 2024, Medicaid spending for Evaluation and Management in Reston increased by $1,496,701, reflecting 125% growth. Some periods had accelerated increases, with significant yearly jumps observed in 2022 and 2023.
Most Medicaid spending in the Evaluation and Management category in 2024 was concentrated within a few Reston ZIP codes. The largest payments were recorded in ZIP code 20190, totaling $2,668,180, and in 20191, amounting to $25,404. Combined, these ZIP codes comprised 100% of Medicaid payments related to Evaluation and Management in Reston that year.
Within Evaluation and Management, most Medicaid payments were associated with a small set of billing codes.
For context, Reston saw a 2.6% increase in Medicaid payments for Evaluation and Management from 2023 to 2024, whereas payments in all claim categories increased by 4.4% citywide during the same time period.
The Centers for Medicare & Medicaid Services reports that Medicaid spending by both federal and state governments totaled about $871.7 billion in fiscal 2023, accounting for approximately 18% of total national health expenditures, a sharp rise from around $613.5 billion in 2019 before the COVID-19 crisis.
This growth equates to nearly 40% over several years, mainly attributed to expanded enrollment and greater utilization during and after the pandemic period.
Recent congressional budget initiatives during the Trump administration have included significant Medicaid funding reductions and structural reforms. Specifically, the “One Big Beautiful Bill Act,” enacted in 2025, is forecasted to trim over $1 trillion from federal Medicaid support in the coming decade and incorporates requirements such as work obligations and higher cost-sharing, factors that could decrease available coverage and resources for some participants. The anticipated effect of these measures is to place greater responsibility for costs on states and limit future federal Medicaid expansion, even as demand remains high nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,196,883 | 4.3% |
| 2021 | $1,429,993 | 19.5% |
| 2022 | $2,067,772 | 44.6% |
| 2023 | $2,624,836 | 26.9% |
| 2024 | $2,693,585 | 2.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $2,693,585 | 47.1% |
| 2 | Radiology Procedures | $1,157,210 | 20.2% |
| 3 | National Codes Established for State Medicaid Agencies | $874,204 | 15.3% |
| 4 | Medicine Services and Procedures | $533,986 | 9.3% |
| 5 | Surgery | $261,416 | 4.6% |
| 6 | Procedures / Professional Services | $99,271 | 1.7% |
| 7 | Pathology and Laboratory Procedures | $58,633 | 1% |
| 8 | Anesthesia | $23,379 | 0.4% |
| 9 | Vision Services | $12,134 | 0.2% |
| 10 | Temporary Codes | $5,263 | 0.1% |
| 11 | Drugs Administered Other than Oral Method | $385 | <0.1% |
| 12 | Coronavirus Diagnostic Panel | $105 | <0.1% |
| 13 | Temporary National Codes (Non-Medicare) | $8 | <0.1% |
| 14 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| 14 | Dental Services | $0 | <0.1% |
| 14 | Medical And Surgical Supplies | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99283 | Emergency dept visit low mdm | $834,083 | 12 |
| 99284 | Emergency dept visit mod mdm | $802,387 | 12 |
| 99214 | Office o/p est mod 30 min | $279,266 | 124 |
| 99282 | Emergency dept visit sf mdm | $185,794 | 12 |
| 99285 | Emergency dept visit hi mdm | $151,160 | 12 |
| 99213 | Office o/p est low 20 min | $133,329 | 65 |
| 99499 | Unlisted e&m service | $113,200 | 12 |
| 99281 | Emr dpt vst mayx req phy/qhp | $68,485 | 11 |
| 99204 | Office o/p new mod 45 min | $52,989 | 16 |
| 99223 | 1st hosp ip/obs high 75 | $20,947 | 11 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $13,653 | 10 |
| 99393 | Prev visit est age 5-11 | $11,983 | 8 |
| 99394 | Prev visit est age 12-17 | $7,608 | 6 |
| 99392 | Prev visit est age 1-4 | $7,260 | 6 |
| 99233 | Sbsq hosp ip/obs high 50 | $6,517 | 5 |
| 99215 | Office o/p est hi 40 min | $1,599 | 1 |
| 99391 | Per pm reeval est pat infant | $1,094 | 1 |
| 99212 | Office o/p est sf 10 min | $1,043 | 1 |
| 99173 | Visual acuity screen | $857 | 11 |
| 99231 | Sbsq hosp ip/obs sf/low 25 | $324 | 1 |
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.
