San Francisco Medicaid providers billed a total of $58,989,700 for Evaluation and Management category services in 2024, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 15.8% uptick compared with the prior year, when $50,956,323 in claims were submitted for the same services.
Medicaid is a public health insurance initiative, managed by individual states and jointly funded by federal and state governments. It provides coverage for low-income individuals and families, seniors, children, and those with disabilities, making it one of the country’s primary health care programs.
Because Medicaid funding is sourced from taxpayers, local billing changes indicate how public health care resources are distributed within a community.
The “Evaluation and Management” grouping encompasses a selection of Medicaid-billed services defined by the type of care delivered, using standardized HCPCS and CPT code groupings. In this report, each billing code was linked to a single service group using standardized code prefixes and numbers, allowing for accurate service comparisons and avoiding duplicate counts over time.
Though Medicaid expenditures rose in multiple service groups, Evaluation and Management ranked fourth by total Medicaid payments in San Francisco for 2024.
Statewide in California, the Evaluation and Management service group was the second-highest by total Medicaid payments in 2024.
Between five years prior and 2024, Medicaid payments attributed to Evaluation and Management in San Francisco climbed by $39,321,153, or 199.9%. The rate of increase accelerated in certain years, with marked gains observed in both 2023 and 2021.
While spending in this category occurred throughout San Francisco, the largest share was concentrated in a small number of ZIP codes. In 2024, ZIP codes 94103, 94143, and 94122 saw Medicaid payments of $15,146,559, $14,738,557, and $8,351,716, respectively, for Evaluation and Management services. These three ZIP codes together represented 64.8% of all category payments in the city for the year.
Medicaid spending within this group was also distributed among only a select few billing codes.
In San Francisco, the 15.8% rise in Medicaid payments for Evaluation and Management services between 2024 and the previous year compared with a 14.5% increase across all Medicaid claim categories citywide for the same period.
According to the Centers for Medicare & Medicaid Services, combined Medicaid spending by federal and state governments reached around $871.7 billion in fiscal year 2023, accounting for about 18% of national health spending, a significant rise from $613.5 billion in 2019 before the COVID-19 pandemic.
This increase amounts to approximately 40% growth in just a few years, largely due to heightened enrollment and greater service utilization during and after the pandemic period.
Recent federal budget legislation from the Trump administration included major proposals to cut federal Medicaid support and alter the program’s structure. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid spending by more than $1 trillion over 10 years and brings new policies such as work requirements and increased cost-sharing that could diminish coverage and funds for certain beneficiaries. These changes may shift a greater share of costs to state governments and limit the pace of federal Medicaid growth, even as the program continues to serve tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $19,668,547 | 8.4% |
| 2021 | $28,221,676 | 43.5% |
| 2022 | $29,762,725 | 5.5% |
| 2023 | $50,956,323 | 71.2% |
| 2024 | $58,989,700 | 15.8% |
| 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 |
|---|---|---|---|
| 99214 | Office o/p est mod 30 min | $10,776,562 | 5,104 |
| 99215 | Office o/p est hi 40 min | $10,054,393 | 2,312 |
| 99213 | Office o/p est low 20 min | $7,645,763 | 6,067 |
| 99284 | Emergency dept visit mod mdm | $6,143,223 | 1,311 |
| 99285 | Emergency dept visit hi mdm | $3,794,774 | 889 |
| 99202 | Office o/p new sf 15 min | $2,944,584 | 125 |
| 99283 | Emergency dept visit low mdm | $2,228,677 | 387 |
| 99233 | Sbsq hosp ip/obs high 50 | $2,132,534 | 795 |
| 99212 | Office o/p est sf 10 min | $1,509,970 | 1,398 |
| 99204 | Office o/p new mod 45 min | $1,462,957 | 487 |
| 99291 | Critical care first hour | $1,165,486 | 242 |
| 99203 | Office o/p new low 30 min | $1,099,468 | 564 |
| 99443 | $1,051,629 | 64 | |
| 98960 | Edu&trn pt self-mgmt nqhp 1 | $866,134 | 35 |
| 99281 | Emr dpt vst mayx req phy/qhp | $847,688 | 175 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $657,256 | 399 |
| 99309 | Sbsq nf care moderate mdm 30 | $505,875 | 154 |
| 99205 | Office o/p new hi 60 min | $469,586 | 125 |
| 99282 | Emergency dept visit sf mdm | $458,928 | 29 |
| 99223 | 1st hosp ip/obs high 75 | $383,616 | 219 |
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.
