In 2024, Pleasanton Medicaid providers charged $6,929,305 for services under the Evaluation and Management category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This figure represents a 9.2% increase from 2023, when claims for the same services totaled $6,345,166.
Medicaid is a government-run health insurance program that operates at the state level and receives funding from both federal and state sources. The program supports low-income individuals and families, seniors, children, and people with disabilities, making it a central component of the U.S. health care landscape.
Since Medicaid payments are sourced from taxpayers, fluctuations in local billing highlight how a community allocates public health care resources.
The Evaluation and Management category includes a set of Medicaid-billed services grouped by the nature of care delivered, identified through standardized HCPCS and CPT code prefixes and numeric ranges. For this report, each code was assigned to a single category, allowing related services to be counted together without duplication and preserving consistent rankings across years.
While Medicaid spending grew across various service groups, Evaluation and Management ranked third among Pleasanton service categories by total Medicaid payments in 2024.
Statewide in California, Evaluation and Management took the second spot among categories for total Medicaid payments in 2024.
Between 2019 and 2024, Medicaid payments for the Evaluation and Management category in Pleasanton increased by $2,812,455, or 68.3%. Spending surged during certain intervals, notably in 2021 and 2022, with substantial year-over-year gains.
Although services in the Evaluation and Management category were provided throughout Pleasanton, payments were mainly concentrated in a small number of ZIP codes. In 2024, ZIP code 94588 accounted for $6,125,436, and 94566 for $803,868, together representing 100% of Medicaid payments for the Evaluation and Management category in the city during the year.
A limited number of billing codes represented the bulk of Medicaid payments within the Evaluation and Management group.
Comparison between 2024 and 2023 shows Medicaid payments for Evaluation and Management services in Pleasanton increased by 9.2%, while all Medicaid claim categories in the city saw a 7.3% rise during the same period.
According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending combined reached approximately $871.7 billion in fiscal year 2023, or about 18% of total national health expenditures—up from roughly $613.5 billion in 2019, before the COVID-19 pandemic.
This growth amounts to an increase of nearly 40% in a span of a few years, primarily driven by higher enrollment and utilization both during and after the pandemic.
Recent federal budget actions under the Trump administration have brought major proposals to reduce federal Medicaid funding and reshape the program. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to decrease federal Medicaid spending by more than $1 trillion over the next decade. It establishes policies such as work requirements and higher cost-sharing, which may lead to reduced coverage and funding for some beneficiaries. These measures are projected to shift added costs onto states and curb the expansion of federal Medicaid support, even as the program continues to serve tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,116,849 | -15.7% |
| 2021 | $5,185,002 | 25.9% |
| 2022 | $5,938,724 | 14.5% |
| 2023 | $6,345,165 | 6.8% |
| 2024 | $6,929,305 | 9.2% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $9,548,534 | 28.8% |
| 2 | Medicine Services and Procedures | $7,404,499 | 22.3% |
| 3 | Evaluation and Management | $6,929,305 | 20.9% |
| 4 | Procedures / Professional Services | $4,800,064 | 14.5% |
| 5 | Radiology Procedures | $1,401,675 | 4.2% |
| 6 | Pathology and Laboratory Procedures | $1,390,903 | 4.2% |
| 7 | Alcohol and Drug Abuse Treatment | $1,166,606 | 3.5% |
| 8 | Dental Services | $198,651 | 0.6% |
| 9 | Anesthesia | $114,962 | 0.3% |
| 10 | Drugs Administered Other than Oral Method | $85,607 | 0.3% |
| 11 | Temporary National Codes (Non-Medicare) | $68,857 | 0.2% |
| 12 | Surgery | $53,806 | 0.2% |
| 13 | Temporary Codes | $32,593 | 0.1% |
| 14 | Vision Services | $4,072 | <0.1% |
| 15 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $3,188 | <0.1% |
| 16 | Administrative, Miscellaneous and Investigational | $2,917 | <0.1% |
| 17 | Durable Medical Equipment | $536 | <0.1% |
| 18 | Medical And Surgical Supplies | $82 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99285 | Emergency dept visit hi mdm | $2,423,696 | 841 |
| 99284 | Emergency dept visit mod mdm | $2,355,080 | 926 |
| 99283 | Emergency dept visit low mdm | $342,756 | 360 |
| 99214 | Office o/p est mod 30 min | $309,537 | 312 |
| 99490 | Chrnc care mgmt staff 1st 20 | $263,126 | 23 |
| 99070 | Special supplies phys/qhp | $254,679 | 12 |
| 99439 | Chrnc care mgmt staf ea addl | $187,821 | 21 |
| 99213 | Office o/p est low 20 min | $157,985 | 267 |
| 99231 | Sbsq hosp ip/obs sf/low 25 | $148,471 | 13 |
| 99291 | Critical care first hour | $104,791 | 65 |
| 99212 | Office o/p est sf 10 min | $81,271 | 164 |
| 99454 | Rem mntr physiol param 16-30 | $63,705 | 20 |
| 99457 | Rpm tx mgmt 1st 20 min | $43,227 | 16 |
| 99215 | Office o/p est hi 40 min | $38,776 | 34 |
| 99204 | Office o/p new mod 45 min | $36,126 | 36 |
| 99203 | Office o/p new low 30 min | $22,970 | 39 |
| 99205 | Office o/p new hi 60 min | $14,770 | 14 |
| 99393 | Prev visit est age 5-11 | $12,411 | 18 |
| 98976 | Rtm dev sply resp sys 16-30d | $10,893 | 6 |
| 98977 | Rtm dev sply mscskl 16-30 d | $8,599 | 6 |
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.
