South Dakota sees 23.4% rise in Medicaid payments for Evaluation and Management services in 2024

In 2024, South Dakota Medicaid paid $92,284,961 for services in the Evaluation and Management category, figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This represents a 23.4% increase over 2023, when $74,769,164 in claims were submitted by providers.

Medicaid, a public health insurance initiative run by each state and jointly financed by state and federal governments, covers low-income people and families, seniors, children, and individuals with disabilities, making it a substantial portion of the U.S. health care system. More details on Medicaid funding appear here.

Shifts in Medicaid payments, which are taxpayer-funded, reflect how public health dollars are distributed within different communities.

The Evaluation and Management category includes a set of Medicaid-billed services defined by the nature of care provided, based on standard HCPCS and CPT code groups. Each billing code was placed into a single service category using uniform code prefixes and number ranges, ensuring services were grouped consistently and ranked accurately across years, without double counting.

Where categories include several subtypes of services, they are combined to represent types of care commonly billed together in Medicaid, such as office visits, diagnostic testing, and therapeutic services.

During the five years leading to 2024, Medicaid payments for Evaluation and Management services in South Dakota rose by $66,532,965, or 258.4%. Certain years, like 2021 and 2022, saw particularly strong gains in spending.

While these services were billed across the state, Medicaid payments were focused within a handful of ZIP codes. In 2024, ZIP Code 57105 received $17,597,351 (19.1% of the total), ZIP Code 57702 had $15,009,013 (16.3%), and ZIP Code 57701 accounted for $10,615,170 (11.5%).

Altogether, these top three ZIP codes made up 46.8% of all Medicaid payments for Evaluation and Management services in South Dakota for the year.

Statewide, when looking at all Medicaid claim categories, payments climbed 17.4% from 2023 to 2024.

Although spending was up in several claim categories, Evaluation and Management was among the top two by total Medicaid payments in 2024 statewide.

According to the Centers for Medicare & Medicaid Services, joint federal and state Medicaid expenditures reached about $871.7 billion in fiscal year 2023, roughly 18% of total U.S. health spending, a sharp increase from an estimated $613.5 billion in 2019, before the COVID-19 pandemic.

This marks about 40% growth in a few years, driven by expanded coverage and higher service use during and after the pandemic.

Recent federal budget laws enacted under the Trump administration have included large-scale measures cutting federal Medicaid funding and changing the way the program operates. For example, the “One Big Beautiful Bill Act,” approved in 2025, is set to reduce federal Medicaid support by over $1 trillion in the next decade and brings in requirements like work mandates and higher cost-sharing that could limit benefits and funding for some enrollees. States are expected to bear more costs and face slower federal spending growth, though the program still covers tens of millions nationwide.