Medicaid providers in Burlington submitted $59,703,125 in claims for Evaluation and Management services during 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents a 2.3% rise from 2023, when providers billed $58,376,093 for these services.
Medicaid, a public insurance program operated by states and funded by both federal and state governments, serves low-income residents, seniors, children and individuals with disabilities, making it a significant component of the national health care system.
Because taxpayer dollars fund Medicaid payments, shifts in local billing levels reflect how community health care resources are distributed.
The “Evaluation and Management” group includes a range of Medicaid services identified by type of care, based on consistent HCPCS and CPT code sets. For this report, each billing code was mapped to a single service group using established code prefixes and number ranges. This method helped examine similar services together, while preventing double counting and ensuring accurate year-to-year comparisons.
Although several Medicaid service groups saw increased spending, Evaluation and Management accounted for the highest Medicaid payments in Burlington during 2024.
Statewide in Vermont, Evaluation and Management also led in total Medicaid payments in 2024.
Reviewing the five years preceding 2024, Medicaid payments related to Evaluation and Management in Burlington grew by $35,785,519, or 149.6%. Spending accelerated at certain points, with significant annual increases seen in 2020 and 2021.
While Evaluation and Management care costs spread throughout the city, payment amounts were concentrated in a few ZIP codes. In 2024, ZIP code 05401 recorded $59,703,125 in Medicaid payments for these services, and 05408 recorded $0. Combined, these two ZIP codes represented 100% of Burlington’s Medicaid payments for Evaluation and Management in that year.
Individual billing codes within the Evaluation and Management group also saw payment concentration.
Compared to a 2.3% increase in Evaluation and Management Medicaid payments between 2024 and 2023, all Medicaid claim categories citywide grew by 1.5% during the same timeframe.
Data from the Centers for Medicare & Medicaid Services show that federal and state Medicaid spending combined reached approximately $871.7 billion in fiscal year 2023, representing about 18% of total national health expenditures, a substantial rise from $613.5 billion in 2019 prior to the COVID-19 pandemic.
The increase reflects nearly 40% growth in several years, driven mostly by higher enrollment and utilization during and after the pandemic.
Recent federal budget measures enacted during the Trump administration included proposals to decrease federal Medicaid funding and overhaul program design. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid support by over $1 trillion over the coming decade, introducing work requirements and increased cost-sharing that may lower coverage and funding for some users. These policies are anticipated to place more financial responsibility on states and constrain federal Medicaid growth while the program continues serving millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $23,917,605 | 958.1% |
| 2021 | $50,235,101 | 110% |
| 2022 | $58,089,150 | 15.6% |
| 2023 | $58,376,092 | 0.5% |
| 2024 | $59,703,125 | 2.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $59,703,125 | 62.7% |
| 2 | Alcohol and Drug Abuse Treatment | $22,831,074 | 24% |
| 3 | National Codes Established for State Medicaid Agencies | $8,122,460 | 8.5% |
| 4 | Medicine Services and Procedures | $1,421,507 | 1.5% |
| 5 | Ambulance and Other Transport Services and Supplies | $1,020,407 | 1.1% |
| 6 | Temporary National Codes (Non-Medicare) | $789,814 | 0.8% |
| 7 | Dental Services | $524,901 | 0.6% |
| 8 | Radiology Procedures | $199,866 | 0.2% |
| 9 | Drugs Administered Other than Oral Method | $196,016 | 0.2% |
| 10 | Surgery | $161,813 | 0.2% |
| 11 | Procedures / Professional Services | $147,456 | 0.2% |
| 12 | Pathology and Laboratory Procedures | $132,844 | 0.1% |
| 13 | Anesthesia | $2,671 | <0.1% |
| 14 | Administrative, Miscellaneous and Investigational | $2,133 | <0.1% |
| 15 | Temporary Codes | $427 | <0.1% |
| 16 | Enteral and Parenteral Therapy | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99199 | Unlisted special svc px/rprt | $58,402,605 | 22 |
| 99214 | Office o/p est mod 30 min | $375,981 | 1,200 |
| 99213 | Office o/p est low 20 min | $205,180 | 929 |
| 99285 | Emergency dept visit hi mdm | $164,201 | 277 |
| 99284 | Emergency dept visit mod mdm | $116,004 | 289 |
| 99215 | Office o/p est hi 40 min | $113,936 | 124 |
| 99204 | Office o/p new mod 45 min | $71,089 | 66 |
| 99203 | Office o/p new low 30 min | $42,892 | 91 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $42,632 | 72 |
| 99291 | Critical care first hour | $41,651 | 31 |
| 99233 | Sbsq hosp ip/obs high 50 | $31,850 | 43 |
| 99205 | Office o/p new hi 60 min | $23,793 | 23 |
| 98942 | Chiropractic manj 5 regions | $15,435 | 8 |
| 99283 | Emergency dept visit low mdm | $11,531 | 47 |
| 99479 | Sbsq ic lbw inf 1,500-2,500 | $6,131 | 3 |
| 99212 | Office o/p est sf 10 min | $5,696 | 39 |
| 99231 | Sbsq hosp ip/obs sf/low 25 | $5,229 | 33 |
| 99391 | Per pm reeval est pat infant | $4,779 | 8 |
| 99309 | Sbsq nf care moderate mdm 30 | $4,125 | 22 |
| 99223 | 1st hosp ip/obs high 75 | $3,686 | 5 |
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.
