Medicaid Evaluation and Management payments in Atherton up 185% in 2024

Providers serving Medicaid patients in Atherton billed $75,241 for Evaluation and Management services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents a 185% increase over 2023, when claims submitted for the same services totaled $26,403.

Medicaid, a state-run public health insurance program funded by both federal and state governments, provides coverage for low-income individuals and families, seniors, children and people with disabilities, making it one of the major segments of the U.S. health care system.

Because taxpayer funding supports Medicaid payments, shifts in local billing patterns help illustrate how public health funds are distributed within a community.

The “Evaluation and Management” designation applies to a set of Medicaid-billed services defined according to the type of care delivered, using standardized HCPCS and CPT code groupings. Each billing code in this analysis was assigned to only one service category based on consistent code prefixes and numeric ranges, enabling analysis of comparable services together without duplication and maintaining reliable ranking across years.

Although Medicaid spending grew in several service categories, Evaluation and Management placed second in Atherton for total Medicaid payments in 2024.

Statewide, the Evaluation and Management category was also ranked second in California for total Medicaid payment volume in 2024.

Medicaid payments for Evaluation and Management services in Atherton climbed by $43,985, or 140.7%, in the five years before 2024. Certain periods saw particularly strong annual growth, with notable increases documented in 2022 and 2022.

Most spending in the Evaluation and Management category was concentrated in a few ZIP codes in Atherton. In 2024, ZIP code 94027 accounted for $75,240, making up 100% of Medicaid payments related to the category in the city for that year.

Within Evaluation and Management, a select number of individual billing codes accounted for much of the Medicaid spending.

For perspective, Medicaid payments for Evaluation and Management in Atherton rose by 185% between 2024 and 2023. This compared with a 3.4% overall change for all Medicaid claim categories in Atherton over the same timeframe.

According to the Centers for Medicare & Medicaid Services, Medicaid spending from both federal and state sources reached approximately $871.7 billion in fiscal year 2023, or about 18% of total U.S. health expenditures. This figure marks a significant rise from $613.5 billion in 2019, before the onset of the COVID-19 pandemic.

This growth represents an increase of around 40% over several years, mainly due to broader enrollment and higher utilization during and following the pandemic period.

Recent federal budget measures under the Trump administration have included major plans to cut federal Medicaid spending and change the program’s structure. The “One Big Beautiful Bill Act,” passed in 2025, is expected to reduce federal Medicaid funding by more than $1 trillion over the next 10 years. It also adds requirements such as work qualifications and increased cost-sharing, which could decrease coverage and funding for some enrollees. These policy changes are likely to shift additional financial responsibility to states and curb federal Medicaid growth, even as tens of millions of Americans remain enrolled in the program.

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.