Fallbrook Medicaid providers submitted $340,142 in claims for the Medicine Services and Procedures category in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This total represents an increase of 3.3% compared with 2023, when $329,138 in claims were filed for the same services.
Medicaid, a public health insurance program operated by individual states and funded in partnership by federal and state governments, covers eligible low-income people, seniors, children, and people with disabilities. It constitutes a substantial part of the U.S. health care system.
Since Medicaid funding is sourced from taxpayers, fluctuations in local billing patterns show how public health care resources are distributed locally.
The “Medicine Services and Procedures” group consists of Medicaid services designated by the type of care provided, following standardized HCPCS and CPT code groupings. For this review, each billing code was placed in a single service group using corresponding code prefixes and numeric ranges. This approach enables related services to be analyzed together, avoiding duplicate counting and ensuring accurate year-to-year rankings.
While Medicaid payments increased for several service categories, Medicine Services and Procedures ranked second for total Medicaid expenditures in Fallbrook in 2024.
Statewide in California, Medicine Services and Procedures placed third in total Medicaid payouts in 2024.
Between 2019 and 2024, Medicaid payments in Fallbrook linked to Medicine Services and Procedures rose $191,569, or 128.9%. Growth was particularly strong during certain stretches, including significant annual increases observed in 2023 and 2021.
Although services in the Medicine Services and Procedures category were claimed across the city, most Medicaid payments were concentrated in a small number of ZIP codes. In 2024, ZIP code 92028 accounted for $340,142—representing 100% of Medicaid billings for this category in Fallbrook that year.
Additionally, most Medicaid payments under Medicine Services and Procedures went to a limited set of individual billing codes.
Comparatively, the 3.3% uptick in Fallbrook’s Medicine Services and Procedures Medicaid payments between 2024 and 2023 stands against a 30.4% change across all Medicaid claim categories in the city during the same timeframe.
Centers for Medicare & Medicaid Services data show combined federal and state Medicaid expenditures reached about $871.7 billion in fiscal 2023, accounting for around 18% of all national health spending. This is a substantial rise from about $613.5 billion in 2019, before the COVID-19 pandemic.
The increase reflects a growth rate of roughly 40% over several years, mainly due to expanded enrollment and higher use during and after the pandemic.
Recent federal legislation from the Trump administration contains major plans to reduce national Medicaid funding and alter the program’s structure. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is set to decrease federal Medicaid spending by more than $1 trillion over the coming decade. The act brings policies such as work requirements and heightened cost-sharing, which could limit coverage and funding for some recipients. As a result, states may face increased financial responsibility, while federal support for Medicaid may grow more slowly—even as the program continues helping tens of millions of U.S. residents.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $148,573 | -29.8% |
| 2021 | $251,963 | 69.6% |
| 2022 | $158,784 | -37% |
| 2023 | $329,137 | 107.3% |
| 2024 | $340,142 | 3.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Procedures / Professional Services | $489,942 | 39.6% |
| 2 | Medicine Services and Procedures | $340,142 | 27.5% |
| 3 | Evaluation and Management | $184,322 | 14.9% |
| 4 | Dental Services | $100,225 | 8.1% |
| 5 | Ambulance and Other Transport Services and Supplies | $57,536 | 4.7% |
| 6 | Surgery | $23,420 | 1.9% |
| 7 | National Codes Established for State Medicaid Agencies | $21,580 | 1.7% |
| 8 | Alcohol and Drug Abuse Treatment | $13,198 | 1.1% |
| 9 | Vision Services | $5,973 | 0.5% |
| 10 | Pathology and Laboratory Procedures | $59 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 90834 | Psytx w pt 45 minutes | $135,491 | 6 |
| 92508 | Tx sp lang voice comm group | $109,478 | 20 |
| 96130 | Psycl tst eval phys/qhp 1st | $30,780 | 7 |
| 92523 | Speech sound lang comprehen | $10,825 | 7 |
| 92012 | Intrm oph exam est patient | $10,273 | 8 |
| 96158 | Hlth bhv ivntj indiv 1st 30 | $9,898 | 5 |
| 90832 | Psytx w pt 30 minutes | $6,961 | 12 |
| 92521 | Evaluation of speech fluency | $6,045 | 7 |
| 92551 | Pure tone hearing test air | $5,888 | 10 |
| 92524 | Behavral qualit analys voice | $5,300 | 7 |
| 92340 | Fit spectacles monofocal | $3,453 | 8 |
| 90791 | Psych diagnostic evaluation | $2,564 | 3 |
| 92014 | Compre oph exam est pt 1/> | $1,138 | 2 |
| 92004 | Compre oph exam new pt 1/> | $912 | 2 |
| 92015 | Determine refractive state | $511 | 5 |
| 93005 | Electrocardiogram tracing | $453 | 3 |
| 96373 | Ther/proph/diag inj ia | $84 | 3 |
| 96127 | Brief emotional/behav assmt | $79 | 3 |
| 90471 | Immunization admin | $0 | 7 |
| 90656 | Iiv3 vacc no prsv 0.5 ml im | $0 | 4 |
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.