San Marcos Medicaid providers billed $5,771,913 for Evaluation and Management services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represented a 65.6% rise from 2023, when providers filed $3,486,204 in claims for these services.
Medicaid, a public health insurance program operated by states and funded through federal and state government partnership, serves low-income people, seniors, children, and those with disabilities. It stands as one of the largest components of the U.S. health system.
Because Medicaid payments are taxpayer funded, fluctuations in local billing reflect the way public health care resources are distributed within a community.
The “Evaluation and Management” designation covers Medicaid-billed services classified by care type, based on standardized HCPCS and CPT code groupings. For this review, each code was clearly assigned to a single service category using consistent prefixes and numeric ranges to allow accurate grouping, eliminate overlap, and maintain consistent rankings over time.
Medicaid spending rose in multiple categories, but Evaluation and Management stood as the third highest by total Medicaid payments in San Marcos in 2024.
For the state of California, Evaluation and Management was ranked second by total Medicaid payments in 2024.
During the five-year span leading up to 2024, Medicaid payments for Evaluation and Management in San Marcos increased by $4,017,248, or 228.9%, with accelerated growth and notable annual increases observed during 2023 and 2021.
Although payments for Evaluation and Management services were distributed throughout San Marcos, funding was concentrated in a few ZIP codes. The ZIP codes with the highest Medicaid payments under this category in 2024 were 92078 at $5,381,583, 92069 with $386,563, and 92096 with $3,765. Combined, these 3 ZIP codes accounted for 100% of related Medicaid spending in San Marcos that year.
A limited set of individual billing codes made up the majority of Medicaid payments within the Evaluation and Management category.
In comparison, Medicaid payments tied to Evaluation and Management in San Marcos rose by 65.6% from 2023 to 2024, while all claim categories in the city saw a 6.2% change over the same timeframe.
According to the Centers for Medicare & Medicaid Services, overall Medicaid spending by federal and state governments totaled about $871.7 billion in fiscal year 2023. This represented approximately 18% of total health expenditures nationally, a sharp increase from around $613.5 billion in 2019, prior to the COVID-19 pandemic.
This jump shows roughly 40% growth in a few years, driven mostly by expanded enrollment and greater service use during and after the pandemic.
Recent federal budget measures under the Trump administration have proposed notable reductions in federal Medicaid funding and changes to program structure. For example, the “One Big Beautiful Bill Act,” which became law in 2025, is anticipated to cut more than $1 trillion in federal Medicaid support over 10 years and introduces requirements such as work mandates and increased cost-sharing, potentially impacting coverage and funding for some recipients. These adjustments are expected to shift more financial responsibility to states and limit federal Medicaid growth, even as tens of millions of Americans rely on the program.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,754,665 | 37.4% |
| 2021 | $2,439,787 | 39% |
| 2022 | $2,153,807 | -11.7% |
| 2023 | $3,486,204 | 61.9% |
| 2024 | $5,771,913 | 65.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $20,511,256 | 48% |
| 2 | Medicine Services and Procedures | $7,253,462 | 17% |
| 3 | Evaluation and Management | $5,771,913 | 13.5% |
| 4 | Dental Services | $2,489,738 | 5.8% |
| 5 | Temporary National Codes (Non-Medicare) | $1,631,743 | 3.8% |
| 6 | Procedures / Professional Services | $1,137,954 | 2.7% |
| 7 | Drugs Administered Other than Oral Method | $1,121,141 | 2.6% |
| 8 | Surgery | $822,696 | 1.9% |
| 9 | Medical And Surgical Supplies | $780,773 | 1.8% |
| 10 | Radiology Procedures | $402,090 | 0.9% |
| 11 | Pathology and Laboratory Procedures | $358,873 | 0.8% |
| 12 | Alcohol and Drug Abuse Treatment | $210,027 | 0.5% |
| 13 | Ambulance and Other Transport Services and Supplies | $166,044 | 0.4% |
| 14 | Anesthesia | $25,544 | 0.1% |
| 15 | Vision Services | $12,047 | <0.1% |
| 16 | Enteral and Parenteral Therapy | $3,991 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $3,864 | <0.1% |
| 18 | Temporary Codes | $787 | <0.1% |
| 19 | Outpatient PPS | $20 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99283 | Emergency dept visit low mdm | $2,550,568 | 12 |
| 99214 | Office o/p est mod 30 min | $1,119,017 | 488 |
| 99223 | 1st hosp ip/obs high 75 | $517,080 | 20 |
| 99284 | Emergency dept visit mod mdm | $462,230 | 12 |
| 99291 | Critical care first hour | $297,837 | 11 |
| 99204 | Office o/p new mod 45 min | $236,592 | 66 |
| 99213 | Office o/p est low 20 min | $189,621 | 715 |
| 99282 | Emergency dept visit sf mdm | $154,841 | 11 |
| 99233 | Sbsq hosp ip/obs high 50 | $153,636 | 20 |
| 99239 | Hosp ip/obs dschrg mgmt >30 | $33,560 | 20 |
| 99497 | Advncd care plan 30 min | $14,069 | 11 |
| 99457 | Rpm tx mgmt 1st 20 min | $10,930 | 9 |
| 99212 | Office o/p est sf 10 min | $8,612 | 397 |
| 99232 | Sbsq hosp ip/obs moderate 35 | $8,481 | 10 |
| 98941 | Chiropract manj 3-4 regions | $4,462 | 59 |
| 99203 | Office o/p new low 30 min | $2,392 | 52 |
| 99222 | 1st hosp ip/obs moderate 55 | $1,498 | 10 |
| 99205 | Office o/p new hi 60 min | $1,087 | 1 |
| 99231 | Sbsq hosp ip/obs sf/low 25 | $1,006 | 10 |
| 99458 | Rpm tx mgmt ea addl 20 min | $905 | 1 |
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.