Pleasanton Medicaid providers billed $7,404,500 for Medicine Services and Procedures in 2024, based on information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 32.6% rise over 2023, when $5,586,010 in claims were submitted for the same services.
Medicaid, a public health insurance program run by states and funded by both federal and state governments, covers individuals and families with low incomes, as well as seniors, children, and people with disabilities. It is a major component of the U.S. health care system.
Shifts in Medicaid billing at the local level reflect how taxpayer-funded public health spending is distributed within communities.
The “Medicine Services and Procedures” category groups Medicaid-reimbursed services by type, relying on standardized HCPCS and CPT codes. For this study, service codes were matched to category using their code prefixes and numeric ranges to group related care, eliminate double counting, and maintain year-by-year comparisons.
Spending increases were recorded in multiple categories, but Medicine Services and Procedures was the second-largest category for Medicaid spending in Pleasanton for 2024.
Statewide, Medicine Services and Procedures ranked third among Medicaid categories in California for 2024.
Over the five years prior to 2024, total Medicaid payments for Medicine Services and Procedures in Pleasanton rose by $4,879,602, or 193.3%. The rate of spending accelerated for certain years, especially with notable annual increases in 2023 and 2022.
Payments in the Medicine Services and Procedures category were not spread evenly but were highly concentrated in a few ZIP codes. In 2024, ZIP code 94588 had $5,314,971 and 94566 saw $2,089,528 in Medicaid payments, combining for 100% of the category’s city payments that year.
Medicaid reimbursement in this category was also mainly tied to a select group of billing codes.
When compared with a 32.6% increase in the Medicine Services and Procedures category between 2024 and 2023, all Medicaid claim categories across Pleasanton saw an overall 7.3% change for the same period.
The Centers for Medicare & Medicaid Services reports that combined federal and state Medicaid spending hit about $871.7 billion in the 2023 fiscal year, representing around 18% of all national health expenditures. This is a substantial jump from roughly $613.5 billion in 2019, the year before COVID-19.
This approximate 40% growth over a few years was largely due to wider enrollment and greater utilization during and following the pandemic.
Recent federal budget actions under the Trump administration have brought major proposals to cut federal Medicaid funding and reshape the program. For instance, the “One Big Beautiful Bill Act,” signed into law in 2025, is slated to trim federal Medicaid funds by over $1 trillion during the next 10 years. The measure adds work requirements and higher cost-sharing that may limit both coverage and financial support for certain beneficiaries. As a result, expenses may shift more heavily to states and restrain federal support, even while tens of millions continue relying on Medicaid.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $2,524,897 | -2.5% |
| 2021 | $3,005,001 | 19% |
| 2022 | $3,733,121 | 24.2% |
| 2023 | $5,586,010 | 49.6% |
| 2024 | $7,404,499 | 32.6% |
| 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 |
|---|---|---|---|
| 97153 | Adaptive behavior tx by tech | $1,984,825 | 10 |
| 90999 | Unlisted dialysis procedure | $693,734 | 18 |
| 90832 | Psytx w pt 30 minutes | $578,104 | 157 |
| 97530 | Therapeutic activities | $561,165 | 125 |
| 97155 | Adapt behavior tx phys/qhp | $540,699 | 11 |
| 97140 | Manual therapy 1/> regions | $386,358 | 116 |
| 97112 | Neuromuscular reeducation | $380,465 | 85 |
| 97110 | Therapeutic exercises | $335,335 | 92 |
| 93229 | Remote 30 day ecg tech supp | $327,146 | 21 |
| 96374 | Ther/proph/diag inj iv push | $180,182 | 12 |
| 97151 | Bhv id assmt by phys/qhp | $152,198 | 10 |
| 93306 | Tte w/doppler complete | $121,921 | 20 |
| 96375 | Tx/pro/dx inj new drug addon | $115,417 | 12 |
| 93010 | Electrocardiogram report | $108,934 | 362 |
| 97014 | Electric stimulation therapy | $103,697 | 100 |
| 97010 | Hot or cold packs therapy | $100,033 | 103 |
| 90834 | Psytx w pt 45 minutes | $97,413 | 33 |
| 96365 | Ther/proph/diag iv inf init | $75,858 | 12 |
| 97162 | Pt eval mod complex 30 min | $63,022 | 28 |
| 92508 | Tx sp lang voice comm group | $59,858 | 10 |
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.
