Santa Clara Medicaid providers billed $6,316,573 for Evaluation and Management services in 2024, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 1666% jump from 2023, when billings for this service category totaled $357,668.
Medicaid is a state-operated public health insurance program supported by federal and state governments together. It serves low-income people and families, seniors, children, and those with disabilities, making it a major part of the U.S. health care landscape.
Since Medicaid relies on taxpayer dollars, shifts in local billing levels indicate changes in community distribution of public health care funding.
The Evaluation and Management classification covers a set of Medicaid-billed services categorized by type of care using standardized HCPCS and CPT code groupings. This analysis assigned each billing code to an individual service category by matching code prefixes and specified numeric ranges, grouping related services together to avoid both double counting and ranking inaccuracies across years.
Evaluation and Management led all service categories for total Medicaid payments in Santa Clara in 2024, as Medicaid spending rose for several service categories.
On the statewide level, Evaluation and Management was second in California by total Medicaid payment in 2024.
Reviewing a five-year span leading to 2024, Santa Clara’s Medicaid payments in the Evaluation and Management category rose by $6,207,912, equating to a 5713.1% increase. The most significant spending surges occurred in 2021 and 2023.
While claims in the Evaluation and Management category were distributed throughout Santa Clara, payments mainly came from a few ZIP codes. In 2024, ZIP code 95051 generated $6,294,306 in payments, while 95050 accounted for $22,266. These two ZIP codes combined made up 100% of Santa Clara’s Medicaid spending for this category during the year.
Within this category, a small subset of billing codes accounted for the bulk of Santa Clara’s Medicaid payments.
For reference, between 2023 and 2024, Medicaid claims for Evaluation and Management services in Santa Clara shot up 1666%, versus a citywide increase of 632.5% spanning all Medicaid categories over the same period.
The Centers for Medicare & Medicaid Services reported that in fiscal year 2023, joint federal and state Medicaid spending reached nearly $871.7 billion, or about 18% of all U.S. health expenditures—up considerably from about $613.5 billion in 2019, prior to the COVID-19 pandemic.
This represents roughly 40% growth over several years, attributed mainly to higher enrollment and increased use during and after the pandemic period.
Recent federal budget actions under the Trump administration introduced notable plans to decrease federal Medicaid support and reconfigure the program. One example is the “One Big Beautiful Bill Act,” passed in 2025, which is expected to reduce federal payments to Medicaid by more than $1 trillion over the next decade. The legislation also implements work requirements and higher individual cost-sharing, potentially reducing access and funding for some beneficiaries. These policies are projected to increase state-level financial responsibility and constrain growth of federal Medicaid aid, even as the program continues to cover tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $108,660 | 6.2% |
| 2021 | $192,315 | 77% |
| 2022 | $247,452 | 28.7% |
| 2023 | $357,668 | 44.5% |
| 2024 | $6,316,572 | 1666% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $6,316,572 | 33.8% |
| 2 | Radiology Procedures | $3,584,705 | 19.2% |
| 3 | Medicine Services and Procedures | $3,004,641 | 16.1% |
| 4 | Alcohol and Drug Abuse Treatment | $1,532,112 | 8.2% |
| 5 | Procedures / Professional Services | $1,306,097 | 7% |
| 6 | Pathology and Laboratory Procedures | $758,679 | 4.1% |
| 7 | Ambulance and Other Transport Services and Supplies | $600,563 | 3.2% |
| 8 | Temporary Codes | $536,039 | 2.9% |
| 9 | Dental Services | $489,785 | 2.6% |
| 10 | National Codes Established for State Medicaid Agencies | $167,345 | 0.9% |
| 11 | Surgery | $163,068 | 0.9% |
| 12 | Anesthesia | $70,259 | 0.4% |
| 13 | Administrative, Miscellaneous and Investigational | $42,140 | 0.2% |
| 14 | Drugs Administered Other than Oral Method | $39,820 | 0.2% |
| 15 | Durable Medical Equipment | $37,801 | 0.2% |
| 16 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $12,073 | 0.1% |
| 17 | Medical And Surgical Supplies | $2,255 | <0.1% |
| 18 | Temporary National Codes (Non-Medicare) | $6 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99284 | Emergency dept visit mod mdm | $2,247,045 | 394 |
| 99283 | Emergency dept visit low mdm | $975,265 | 141 |
| 99285 | Emergency dept visit hi mdm | $838,353 | 96 |
| 99282 | Emergency dept visit sf mdm | $797,445 | 18 |
| 99213 | Office o/p est low 20 min | $692,980 | 748 |
| 99281 | Emr dpt vst mayx req phy/qhp | $242,482 | 12 |
| 99214 | Office o/p est mod 30 min | $186,047 | 125 |
| 99212 | Office o/p est sf 10 min | $109,880 | 236 |
| 99309 | Sbsq nf care moderate mdm 30 | $80,075 | 41 |
| 99215 | Office o/p est hi 40 min | $40,303 | 14 |
| 99308 | Sbsq nf care low mdm 20 | $25,200 | 15 |
| 98960 | Edu&trn pt self-mgmt nqhp 1 | $16,899 | 10 |
| 99203 | Office o/p new low 30 min | $15,537 | 20 |
| 99392 | Prev visit est age 1-4 | $11,985 | 29 |
| 99441 | $5,452 | 7 | |
| 99393 | Prev visit est age 5-11 | $5,355 | 9 |
| 99202 | Office o/p new sf 15 min | $4,669 | 12 |
| 99442 | $4,496 | 4 | |
| 99349 | Home/res vst est mod mdm 40 | $3,580 | 1 |
| 99391 | Per pm reeval est pat infant | $2,995 | 11 |
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.
