In 2024, Medicaid providers in San Carlos submitted $166,320,039 in claims for services under the Pathology and Laboratory Procedures category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 3.5% increase compared to 2023, when billings for this service type were $160,713,033.
Medicaid is operated by individual states with joint federal and state funding, as explained by the Commonwealth Fund. The program supports low-income families, seniors, children, and people with disabilities, constituting a major segment of the U.S. health care landscape.
Since taxpayer dollars support Medicaid, shifts in local billing provide a view into how public money is distributed for health care in each area.
The “Pathology and Laboratory Procedures” category includes various Medicaid services defined by specific HCPCS and CPT codes. To keep the analysis accurate, each code is placed under one service group using uniform prefixes and number ranges, helping assess service trends, avoiding overlap, and supporting consistent rankings through the years.
Among all Medicaid services, Pathology and Laboratory Procedures garnered the most Medicaid payments in San Carlos for 2024.
Looking at California overall, this service type was the fifth largest Medicaid expenditure in 2024.
Between 2019 and 2024, Medicaid reimbursement for Pathology and Laboratory Procedures in San Carlos climbed $114,437,957, or 220.6%. Growth accelerated during certain intervals, with significant annual increases reported in 2021 and 2020.
Although payments for Pathology and Laboratory Procedures were spread across San Carlos, the bulk was centered in a small set of ZIP codes. In 2024, ZIP code 94070 reported $166,320,038, accounting for 100% of the city’s total payments in this category that year.
Additionally, Medicaid spending in this category was concentrated among just a few distinct billing codes.
Examining claim growth by category, Pathology and Laboratory Procedures increased 3.5% between 2024 and 2023, just below the 3.7% overall Medicaid claims increase reported in San Carlos in the same timeframe.
The Centers for Medicare & Medicaid Services reported combined federal and state Medicaid spending at roughly $871.7 billion for fiscal 2023, representing about 18% of total national health expenditures—up significantly from $613.5 billion in 2019, before COVID-19.
This surge traces to increased enrollment and greater service utilization during and following the pandemic, contributing to an estimated 40% spending rise over this span.
Recent congressional budget measures under the Trump administration have advanced major cuts to federal Medicaid funding and adjusted the program structure. The “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to reduce federal Medicaid funds by over $1 trillion through the next decade and implement policies such as work requirements and greater cost-sharing. These measures could reduce federal support and expansion, shifting increased financial responsibility onto states while the program continues to provide coverage to tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $51,882,082 | 59.1% |
| 2021 | $85,648,305 | 65.1% |
| 2022 | $118,558,866 | 38.4% |
| 2023 | $160,713,033 | 35.6% |
| 2024 | $166,320,038 | 3.5% |
| 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 |
|---|---|---|---|
| 81420 | Fetal chrmoml aneuploidy | $80,863,330 | 36 |
| 81408 | Mopath procedure level 9 | $30,975,736 | 35 |
| 81220 | Cftr gene com variants | $17,967,143 | 36 |
| 81443 | Genetic tstg severe inh cond | $8,738,897 | 43 |
| 81329 | Smn1 gene dos/deletion alys | $5,261,425 | 36 |
| 81161 | Dmd dup/delet analysis | $3,846,642 | 36 |
| 81361 | Hbb gene com variants | $2,616,353 | 36 |
| 81257 | Hba1/hba2 gene | $1,856,441 | 35 |
| 81405 | Mopath procedure level 6 | $1,786,654 | 35 |
| 81401 | Mopath procedure level 2 | $1,481,320 | 36 |
| 81243 | Fmr1 gen aly detc abnl allel | $1,406,926 | 36 |
| 81479 | Unlisted molecular pathology | $1,184,138 | 23 |
| 81400 | Mopath procedure level 1 | $760,777 | 35 |
| 81432 | Hrdtry brst ca-rlatd do 5+ | $741,487 | 16 |
| 81251 | Gba gene | $700,151 | 35 |
| 81255 | Hexa gene | $694,088 | 35 |
| 81422 | Fetal chrmoml microdeltj | $666,367 | 24 |
| 81229 | Cytog alys chrml abnr snpcgh | $635,501 | 13 |
| 81200 | Aspa gene | $633,002 | 35 |
| 81260 | Ikbkap gene | $598,755 | 35 |
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.