Lewiston Medicaid Evaluation and Management payments climb 5.2% in 2024

In 2024, Lewiston Medicaid providers reported $13,494,883 in payments for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total was up 5.2% from 2023, when claims for the same service category reached $12,830,452.

Medicaid is a public insurance program operated by state governments with funding shared by both federal and state governments. It provides coverage for low-income individuals and families, seniors, children, and those with disabilities, and ranks among the largest components of the U.S. health system.

Because Medicaid funding comes from public sources, shifts in local billing levels indicate how health care resources are distributed within each community.

The “Evaluation and Management” designation covers a set of Medicaid-billed services identified by care type, using standard HCPCS and CPT coding groups. For this analysis, service codes were each categorized into one service group through unified code prefixes and ranges, ensuring related services were evaluated together while avoiding duplication and maintaining strong year-on-year rankings.

Although Medicaid expenditures increased in a variety of service groups, Evaluation and Management held the third-highest position by total Medicaid payments in Lewiston in 2024.

Statewide in Maine, Evaluation and Management was the fifth-largest Medicaid payment category in 2024.

From 2019 to 2024, Medicaid payments linked to the Evaluation and Management category in Lewiston grew by $5,547,699—an increase of 69.8%. The pace of spending escalated during select years, and notable gains occurred in 2023 and 2021.

Payments for Evaluation and Management services were spread across Lewiston, but primarily concentrated in a small set of ZIP codes. In 2024, ZIP code 04240 had the largest Medicaid payments connected to Evaluation and Management, accounting for $13,494,882. The top single ZIP code represented 100% of all Lewiston Medicaid payments under this category during the year.

Within the category, Medicaid funds were clustered among specific billing codes.

When measured from 2023 to 2024, Medicaid payments in Lewiston for Evaluation and Management increased 5.2%, while overall Medicaid claims for all categories in the city rose 7.5% in the same period.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending combined reached approximately $871.7 billion in fiscal year 2023—around 18% of total national health spending, up from $613.5 billion in 2019 ahead of the COVID-19 pandemic.

This change equals roughly 40% growth in just a few years, largely driven by greater enrollment and higher use of health care during and following the pandemic.

Recent federal budget measures during the Trump administration included notable proposals to reduce federal Medicaid funding and overhaul how the program is structured. For example, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce over $1 trillion in federal Medicaid expenditures for the next decade. It also adds work requirements and greater cost-sharing, potentially resulting in reduced coverage and funding for affected beneficiaries. These shifts could transfer greater costs to states and place limits on the future growth of federal Medicaid support even as the program continues to cover tens of 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.