San Mateo Medicaid payments for Evaluation and Management services rise to $13.8 million in 2024

In 2024, Medicaid providers in San Mateo billed a total of $13,779,768 for Evaluation and Management services, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represented a 19.5% growth from the prior year, when claims for these services totaled $11,535,221.

Medicaid is a public health insurance initiative operated by states and financed through joint federal-state funding. It provides coverage for low-income individuals, families, seniors, children, and people with disabilities, making it a substantial component of the U.S. health care system.

Since Medicaid is funded by taxpayers, fluctuations in local billing data reveal how public health care resources are distributed within a community.

The “Evaluation and Management” category encompasses a range of Medicaid services determined by the type of care delivered, using standardized groupings of HCPCS and CPT codes. For this report, each billing code was categorized into a single service group using consistent code prefixes and numeric designations, enabling analysis of related services while ensuring ranking accuracy and avoiding duplicate counts over time.

Despite increases across various Medicaid service areas, Evaluation and Management held the fifth spot in San Mateo for total Medicaid payments in 2024.

Across California, Evaluation and Management stood as the second highest Medicaid payment category in 2024.

From five years prior to 2024, San Mateo saw Evaluation and Management Medicaid payments climb by $10,164,876—a 281.2% rise. Certain periods showed especially rapid growth, notably with significant annual increases seen in 2023 and 2022.

While services in this category were provided throughout San Mateo, Medicaid payments were mainly concentrated in specific ZIP codes: 94403 with $12,419,469, 94401 at $829,584, and 94402 with $530,714. All Medicaid payments for Evaluation and Management services in the city during 2024 came from these 3 ZIP codes.

Within this category, Medicaid reimbursements also centered on a limited selection of billing codes.

When compared to overall Medicaid payment changes, the 19.5% increase for Evaluation and Management in San Mateo from 2023 to 2024 exceeded the 8.7% gain seen across all Medicaid service categories in the city during that period.

According to the Centers for Medicare & Medicaid Services, combined Medicaid expenditures reached approximately $871.7 billion in fiscal year 2023, making up about 18% of total national health spending—up from roughly $613.5 billion in 2019 prior to the COVID-19 pandemic.

This shift translates to an increase of around 40% over a few years, which was primarily fueled by expanded enrollment and higher usage before, during, and after the pandemic.

Recent federal budget measures under the Trump administration included significant suggestions to reduce federal Medicaid funding and revise the structure of the program. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to slash over $1 trillion in Medicaid funding over the coming decade and implements policies like work requirements and higher cost-sharing that may lower coverage and support for certain beneficiaries. Experts expect that these changes will result in additional financial burden on states and restrict the expansion of federal funds, though Medicaid will remain a service provider for tens of millions nationwide.

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.