In 2024, North Highlands Medicaid providers billed $536,982 for services in the Evaluation and Management category, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 22% gain compared with 2023, when providers billed $440,327 for the same category.
Medicaid is a public health insurance program overseen by states with funding from both federal and state governments. It serves low-income people and families, seniors, children, and individuals with disabilities, making it one of the largest components of the U.S. health system. More information is available from the Commonwealth Fund.
Since Medicaid funding is sourced from taxpayers, shifts in local billing levels reflect how public health care funds are distributed within a community.
The “Evaluation and Management” group covers Medicaid services defined by care type under specific HCPCS and CPT code sets. For this report, billing codes were categorized by consistent prefixes and number ranges, grouping similar services together while avoiding double counting or altering rankings between years.
Although Medicaid expenditures rose across several categories, Evaluation and Management ranked fourth by total Medicaid payments in North Highlands for 2024.
Statewide in California, the Evaluation and Management category held the second-highest spot by overall Medicaid payments in 2024.
Over the five years prior to 2024, North Highlands saw Medicaid payments related to Evaluation and Management rise by $399,587, or 290.8%. Periods of rapid growth occurred, with notable year-over-year gains in 2021 and 2023.
While Evaluation and Management payments were made citywide, they were concentrated in a small number of ZIP codes. For 2024, ZIP code 95660 accounted for $536,981, representing 100% of Medicaid payments tied to this category in North Highlands.
Payments within this category were also focused around a select group of billing codes.
Comparatively, Evaluation and Management Medicaid payments in North Highlands grew 22% from 2023 to 2024, while overall Medicaid claims in the city increased 41.6% over the same period.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid expenditures reached approximately $871.7 billion in fiscal year 2023, which was about 18% of total U.S. health care spending—up from roughly $613.5 billion in 2019, before the onset of COVID-19.
This increase represents about 40% growth over a few years, driven mostly by higher enrollment and greater health service use during and after the pandemic.
Recent federal budget measures passed under the Trump administration introduced significant changes to Medicaid funding and structure. For example, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid funding by more than $1 trillion over the next 10 years, adding provisions like work requirements and higher cost-sharing. Such changes could lower coverage and funding for some recipients and are projected to shift more costs to states, even as Medicaid continues to cover tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $137,395 | -54.8% |
| 2021 | $346,842 | 152.4% |
| 2022 | $283,549 | -18.2% |
| 2023 | $440,326 | 55.3% |
| 2024 | $536,981 | 22% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $29,120,945 | 87.4% |
| 2 | Medicine Services and Procedures | $1,403,113 | 4.2% |
| 3 | Dental Services | $793,798 | 2.4% |
| 4 | Evaluation and Management | $536,981 | 1.6% |
| 5 | Temporary National Codes (Non-Medicare) | $527,131 | 1.6% |
| 6 | Ambulance and Other Transport Services and Supplies | $510,815 | 1.5% |
| 7 | Drugs Administered Other than Oral Method | $206,141 | 0.6% |
| 8 | Pathology and Laboratory Procedures | $126,421 | 0.4% |
| 9 | Surgery | $63,183 | 0.2% |
| 10 | Procedures / Professional Services | $24,093 | 0.1% |
| 11 | Medical And Surgical Supplies | $9,737 | <0.1% |
| 12 | Radiology Procedures | $3,299 | <0.1% |
| 13 | Temporary Codes | $3,190 | <0.1% |
| 14 | Anesthesia | $1,405 | <0.1% |
| 15 | Vision Services | $1,313 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $152,806 | 259 |
| 99203 | Office o/p new low 30 min | $112,503 | 64 |
| 99212 | Office o/p est sf 10 min | $85,594 | 158 |
| 99202 | Office o/p new sf 15 min | $77,990 | 26 |
| 99214 | Office o/p est mod 30 min | $49,920 | 170 |
| 99211 | Off/op est may x req phy/qhp | $21,659 | 17 |
| 99204 | Office o/p new mod 45 min | $9,744 | 11 |
| 99000 | Specimen handling office-lab | $5,481 | 27 |
| 99391 | Per pm reeval est pat infant | $5,408 | 55 |
| 99393 | Prev visit est age 5-11 | $3,755 | 56 |
| 99394 | Prev visit est age 12-17 | $3,400 | 27 |
| 99392 | Prev visit est age 1-4 | $2,597 | 55 |
| 99395 | Prev visit est age 18-39 | $2,566 | 12 |
| 99396 | Prev visit est age 40-64 | $1,868 | 8 |
| 99381 | Init pm e/m new pat infant | $745 | 6 |
| 99383 | Prev visit new age 5-11 | $496 | 13 |
| 99215 | Office o/p est hi 40 min | $233 | 12 |
| 99188 | App topical fluoride varnish | $108 | 4 |
| 99382 | Init pm e/m new pat 1-4 yrs | $94 | 3 |
| 99173 | Visual acuity screen | $3 | 31 |
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.