Data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows that Medicaid providers in San Carlos billed $3,786,598 for Medicine Services and Procedures in 2024. This amount was 54.2% higher than in 2023, when $2,455,777 was submitted in claims in this category.
Medicaid is a joint federal and state public health insurance program managed by individual states. It serves low-income people and families, children, seniors, and people with disabilities, making it a key component of the U.S. health care system. Learn more about Medicaid funding here.
Because Medicaid financing comes directly from taxpayers, variations in local billing shed light on how a community’s public health care dollars are spent.
The “Medicine Services and Procedures” classification includes a range of Medicaid-billed services, assembled by type of clinical care and based on HCPCS and CPT coding groups. This analysis aligned each billing code to one service category through uniform code prefixes and defined numeric ranges, grouping related services for accurate tracking over time without double counting.
Medicine Services and Procedures accounted for the second-highest total Medicaid payments by category in San Carlos in 2024, as overall Medicaid expenditures grew across multiple categories.
Statewide, Medicine Services and Procedures was the third-ranked Medicaid payment category in California in 2024 by total disbursed funds.
In San Carlos, Medicaid payments for the Medicine Services and Procedures category rose by $2,305,852, or 155.7%, during the five years prior to 2024. Significant year-to-year increases were observed in both 2021 and 2020 during this period of rising spending.
Local Medicaid payments in the Medicine Services and Procedures category were primarily concentrated in a small group of ZIP codes. In 2024, ZIP code 94070 accounted for $3,786,598 of Medicaid payments, making up 100% of all category-related payments for San Carlos that year.
A small set of specific billing codes dominated the Medicaid payments within the Medicine Services and Procedures category in the city.
The 54.2% year-over-year rise in Medicaid payments for this service type in San Carlos, seen from 2023 to 2024, is contrasted by a more modest overall increase of 3.7% across all Medicaid claim categories in the city over the same period.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid spending reached roughly $871.7 billion during fiscal year 2023, representing about 18% of national health care outlays—up sharply from $613.5 billion in 2019, prior to the COVID-19 pandemic.
That increase amounts to around 40% growth in only a few years, attributed mainly to higher enrollment and increased use of services during and after the pandemic.
Recent federal budget measures instituted during the Trump administration include major proposals to decrease federal Medicaid funding and alter program structure. The “One Big Beautiful Bill Act,” enacted in 2025, projects more than $1 trillion in federal Medicaid reductions over a 10-year period, as well as initiation of work requirements and greater cost-sharing, likely leading to reduced coverage and resources for select beneficiaries. States are expected to shoulder more costs and see a curtailed growth in federal support, even though Medicaid continues serving tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,480,746 | 31.9% |
| 2021 | $2,241,329 | 51.4% |
| 2022 | $2,085,176 | -7% |
| 2023 | $2,455,776 | 17.8% |
| 2024 | $3,786,598 | 54.2% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Pathology and Laboratory Procedures | $166,320,038 | 97.4% |
| 2 | Medicine Services and Procedures | $3,786,598 | 2.2% |
| 3 | Medical And Surgical Supplies | $184,271 | 0.1% |
| 4 | Durable Medical Equipment | $172,170 | 0.1% |
| 5 | Alcohol and Drug Abuse Treatment | $137,039 | 0.1% |
| 6 | Evaluation and Management | $80,201 | <0.1% |
| 7 | National Codes Established for State Medicaid Agencies | $18,851 | <0.1% |
| 8 | Drugs Administered Other than Oral Method | $17,554 | <0.1% |
| 9 | Temporary Codes | $6,873 | <0.1% |
| 10 | Dental Services | $3,976 | <0.1% |
| 11 | Surgery | $1,752 | <0.1% |
| 12 | Procedures / Professional Services | $471 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 90999 | Unlisted dialysis procedure | $2,463,994 | 10 |
| 90837 | Psytx w pt 60 minutes | $1,147,548 | 11 |
| 90834 | Psytx w pt 45 minutes | $63,892 | 8 |
| 90791 | Psych diagnostic evaluation | $63,614 | 10 |
| 90832 | Psytx w pt 30 minutes | $15,936 | 6 |
| 92014 | Compre oph exam est pt 1/> | $9,100 | 9 |
| 92250 | Fundus photography w/i&r | $6,363 | 8 |
| 92015 | Determine refractive state | $4,856 | 11 |
| 90677 | Pcv20 vaccine im | $2,863 | 1 |
| 90732 | Ppsv23 vacc 2 yrs+ subq/im | $2,485 | 1 |
| 92004 | Compre oph exam new pt 1/> | $2,234 | 2 |
| 90661 | Cciiv3 vac abx fr 0.5 ml im | $974 | 1 |
| 90653 | Iiv adjuvant vaccine im | $818 | 1 |
| 92083 | Extended visual field xm | $620 | 1 |
| 92133 | Cptrzd oph dx img pst sgm on | $469 | 1 |
| 96040 | $450 | 4 | |
| 95250 | Cont gluc mntr phys/qhp eqp | $373 | 1 |
Note: HCPCS codes are provided for insight into the category. The article’s tallies and rankings derive from standardized groupings, not by separate billing codes.
Data for this story was sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. You can access the original data set here.