San Francisco Medicaid providers billed $32,186,447 for Procedures / Professional Services in 2024, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents a 58.7% rise over 2023, when the same services saw $20,276,892 in Medicaid claims.
Medicaid is a public health insurance program operated at the state level with funding from both federal and state sources, jointly. The program assists low-income families and individuals, children, seniors, and people with disabilities, making it one of the most significant elements in the U.S. health care network.
As Medicaid payments are sourced from taxpayer funds, fluctuations in local billing levels reveal how a community’s public health resources are allocated.
The “Procedures / Professional Services” category includes services billed to Medicaid based on care type, categorized by standard HCPCS and CPT code groupings. This analysis assigned each billing code to a specific service category, using standardized code prefixes and number ranges to group related services. This approach helps maintain accuracy in service rankings and prevents duplicate counting across years.
Spending rose for several Medicaid service categories, with Procedures / Professional Services ranking sixth by total Medicaid payments in San Francisco for 2024.
Statewide in California, Procedures / Professional Services also held the sixth position in overall Medicaid payments for 2024.
Over the five years leading up to 2024, San Francisco saw Medicaid payments for Procedures / Professional Services increase by $28,130,894, an overall growth of 693.6%. Notably, the pace of this growth accelerated during certain periods, with substantial increases seen in 2023 and 2021.
Though Procedures / Professional Services related payments were distributed across San Francisco, the greatest share was concentrated in a select group of ZIP codes. In 2024, ZIP codes 94103 reached $11,122,648, 94110 recorded $8,070,304, and 94158 saw $4,604,400 in Medicaid payments for these services. Combined, these 3 ZIP codes were responsible for 73.9% of all Procedures / Professional Services Medicaid payments citywide that year.
Payments within the Procedures / Professional Services category were also focused among a handful of individual billing codes.
Comparatively, while Procedures / Professional Services spending in San Francisco increased 58.7% from 2023 to 2024, the overall change for all Medicaid claim categories in the city during the same period was 14.5%.
According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending in fiscal year 2023 totaled about $871.7 billion, making up roughly 18% of total national health costs, a significant jump from approximately $613.5 billion in 2019, before the COVID-19 public health emergency.
This increase amounts to an approximate 40% rise in a few years, attributed mainly to growing enrollment and increased use during and following the pandemic.
Recent federal budget actions under the Trump administration brought forward major proposals to cut federal Medicaid support and restructure the program. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to reduce federal Medicaid funding by more than $1 trillion over the next 10 years. It also introduces policies like work requirements and increased cost-sharing, which could impact coverage and overall funding for some recipients. These changes may shift increased costs to states and restrain the federal share of Medicaid, while the program continues to provide insurance to tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,055,553 | 11.2% |
| 2021 | $6,181,087 | 52.4% |
| 2022 | $7,419,123 | 20% |
| 2023 | $20,276,891 | 173.3% |
| 2024 | $32,186,447 | 58.7% |
| 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 |
|---|---|---|---|
| G9012 | Other specified case mgmt | $17,750,214 | 187 |
| G9008 | Mccd,phys coor-care ovrsght | $4,794,162 | 79 |
| G0463 | Hospital outpt clinic visit | $3,543,376 | 110 |
| G2212 | Prolong outpt/office vis | $3,407,564 | 172 |
| G0299 | Hhs/hospice of rn ea 15 min | $1,104,907 | 54 |
| G0151 | Hhcp-serv of pt,ea 15 min | $585,836 | 54 |
| G0152 | Hhcp-serv of ot,ea 15 min | $218,469 | 37 |
| G0378 | Hospital observation per hr | $115,373 | 9 |
| G0008 | Admin influenza virus vac | $111,354 | 198 |
| G9002 | Mccd,maintenance rate | $88,489 | 17 |
| G0155 | Hhcp-svs of csw,ea 15 min | $85,290 | 21 |
| G9007 | Mccd, sch team conf | $77,173 | 11 |
| G0300 | Hhs/hospice of lpn ea 15 min | $52,924 | 14 |
| G0481 | Drug test def 8-14 classes | $45,256 | 13 |
| G0467 | Fqhc visit, estab pt | $44,364 | 39 |
| G0397 | Alcohol/subs interv >30 min | $25,225 | 2 |
| G0162 | Hhc rn e&m plan svs, 15 min | $24,516 | 10 |
| G6015 | Radiation tx delivery imrt | $23,210 | 1 |
| G0480 | Drug test def 1-7 classes | $22,761 | 9 |
| G2012 | Brief check in by md/qhp | $13,419 | 29 |
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.
