San Francisco Medicaid providers reported billing $6,619,911 for Surgery services in 2024, as shown by U.S. Department of Health and Human Services Medicaid Provider Spending data. This total represents a 150.5% increase over 2023, when claims for the same services reached $2,642,575.
Medicaid, a joint federal-state public health insurance program funded by both levels of government, provides coverage for low-income families and individuals, seniors, children and those with disabilities as a core part of the U.S. health care system.
Since Medicaid payments are taxpayer-funded, fluctuations in billing reflect how public funds are distributed for community health care.
The “Surgery” category includes a defined group of services identified by specific HCPCS and CPT code ranges. For this report, each billing code was assigned to one category only, using standardized prefixes and numeric groupings to ensure comprehensive analysis without double counting or ranking inaccuracies.
Although several Medicaid service categories saw increased spending, Surgery was 10th highest by total Medicaid payments in San Francisco in 2024.
Statewide across California, Surgery ranked 12th among Medicaid service categories by total payment in 2024.
Between 2019 and 2024, Medicaid payments for Surgery in San Francisco increased by $5,874,234, or 787.8%. Growth accelerated during select years, with prominent year-over-year jumps in 2023 and 2021.
While funds were distributed across multiple ZIP codes, Surgery-related Medicaid payments in 2024 concentrated notably in three ZIP codes: 94108 ($3,746,259), 94109 ($845,129), and 94115 ($573,083), which together comprised 78% of Surgery-related Medicaid payments in the city.
Within this category, Medicaid expenditures were aggregated into a small selection of procedure codes.
For context, Surgery Medicaid payments in San Francisco rose by 150.5% from 2023 to 2024, compared with a 14.5% increase across all local Medicaid claim categories for the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled about $871.7 billion in fiscal 2023, making up close to 18% of national health expenditures. This is a significant rise from roughly $613.5 billion in 2019, ahead of the COVID-19 pandemic.
This growth represents an approximate 40% surge within several years, largely attributed to increased enrollment and utilization during and following the pandemic.
Recent federal budget measures under the Trump administration have introduced key policy changes affecting Medicaid. The “One Big Beautiful Bill Act,” which became law in 2025, is set to cut more than $1 trillion in federal Medicaid spending over 10 years, adding work requirements and expanding cost-sharing. These adjustments are projected to reduce both coverage and federal funding for some recipients while shifting additional financial responsibility to states.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $745,676 | -7.6% |
| 2021 | $1,382,297 | 85.4% |
| 2022 | $1,095,450 | -20.8% |
| 2023 | $2,642,574 | 141.2% |
| 2024 | $6,619,910 | 150.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $122,692,188 | 26% |
| 2 | Medicine Services and Procedures | $67,599,701 | 14.3% |
| 3 | Alcohol and Drug Abuse Treatment | $63,148,463 | 13.4% |
| 4 | Evaluation and Management | $58,989,700 | 12.5% |
| 5 | Temporary National Codes (Non-Medicare) | $51,371,461 | 10.9% |
| 6 | Procedures / Professional Services | $32,186,447 | 6.8% |
| 7 | Pathology and Laboratory Procedures | $26,518,416 | 5.6% |
| 8 | Radiology Procedures | $12,174,970 | 2.6% |
| 9 | Ambulance and Other Transport Services and Supplies | $10,121,892 | 2.1% |
| 10 | Surgery | $6,619,910 | 1.4% |
| 11 | Anesthesia | $5,233,049 | 1.1% |
| 12 | Dental Services | $4,325,771 | 0.9% |
| 13 | Drugs Administered Other than Oral Method | $1,823,849 | 0.4% |
| 14 | Medical And Surgical Supplies | $1,781,526 | 0.4% |
| 15 | Durable Medical Equipment | $1,701,885 | 0.4% |
| 16 | Hearing Services | $1,324,177 | 0.3% |
| 17 | Chemotherapy Drugs | $1,294,930 | 0.3% |
| 18 | Temporary Codes | $1,268,845 | 0.3% |
| 19 | Administrative, Miscellaneous and Investigational | $854,001 | 0.2% |
| 20 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $680,836 | 0.1% |
| 21 | Orthotic Procedures and services | $335,271 | 0.1% |
| 22 | Prosthetic Procedures | $61,327 | <0.1% |
| 23 | Vision Services | $26,718 | <0.1% |
| 24 | Outpatient PPS | $2,895 | <0.1% |
| 25 | Pathology and Laboratory Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 17999 | Unlistd px skn muc memb subq | $2,361,180 | 13 |
| 17380 | Electrolysis epilation ea 30 | $1,932,755 | 28 |
| 67028 | Injection eye drug | $532,987 | 94 |
| 36415 | Coll venous bld venipuncture | $349,050 | 195 |
| 11721 | Debride nail 6 or more | $203,626 | 198 |
| 11042 | Dbrdmt subq tis 1st 20sqcm/< | $199,011 | 88 |
| 59409 | Obstetrical care | $147,257 | 9 |
| 42820 | Remove tonsils and adenoids | $125,646 | 21 |
| 11056 | Parng/cutg b9 hyprkr les 2-4 | $89,470 | 81 |
| 43239 | Egd biopsy single/multiple | $71,733 | 37 |
| 59425 | Antepartum care only | $53,820 | 10 |
| 31575 | Diagnostic laryngoscopy | $48,199 | 26 |
| 20610 | Drain/inj joint/bursa w/o us | $41,127 | 38 |
| 31579 | Laryngoscopy telescopic | $35,051 | 12 |
| 45385 | Colonoscopy w/lesion removal | $34,045 | 16 |
| 66984 | Xcapsl ctrc rmvl w/o ecp | $33,813 | 10 |
| 17110 | Destruction b9 les up to 14 | $30,882 | 15 |
| 69210 | Remove impacted ear wax uni | $28,538 | 41 |
| 59025 | Fetal non-stress test | $28,295 | 74 |
| 15003 | Wound prep addl 100 cm | $28,197 | 2 |
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.
