Santa Rosa Medicaid providers billed $228,481 for Evaluation and Management services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This total represents a 28.3% uptick from the $178,068 recorded for these services in 2023.
Medicaid, a public health insurance program operated by states and financed by both federal and state governments, covers low-income families and individuals, seniors, children and people with disabilities. It is one of the country’s most significant health care programs.
Because Medicaid funding comes from public sources, adjustments in local billing help indicate shifts in the allocation of public health care spending within communities.
The “Evaluation and Management” designation includes Medicaid-billed care grouped by type, as determined by standard HCPCS and CPT code patterns. For this report, billing codes were placed into individual service categories using established code prefixes and number sequences. This approach allows related services to be reviewed together while eliminating double counting and keeping year-to-year category rankings accurate.
Medicaid expenditures climbed in several service areas, but Evaluation and Management was fourth in Santa Rosa by total Medicaid payments for 2024.
Statewide in New Mexico, Evaluation and Management ranked third among Medicaid payment categories in 2024.
Looking at the five-year period through 2024, Santa Rosa saw a $672,832, or 74.7%, increase in Medicaid payments associated with Evaluation and Management. Notable annual increases occurred in 2023 and 2020.
While Evaluation and Management payments were distributed around Santa Rosa, they were concentrated in a small number of ZIP codes. In 2024, the ZIP code 88435 accounted for $228,481 in Medicaid spending tied to this category, representing 100% of the total for Santa Rosa that year.
Within the Evaluation and Management group, payments were clustered among a select few billing codes.
From 2023 to 2024, Medicaid expenditures in this category climbed 28.3% in Santa Rosa, versus a 0.1% change across all Medicaid billing categories in the city during that time.
According to the Centers for Medicare & Medicaid Services, total state and federal Medicaid spending rose to about $871.7 billion in fiscal 2023, making up around 18% of overall U.S. health expenditures. That marks a steep jump from roughly $613.5 billion in 2019, before the COVID-19 crisis.
This increase amounts to nearly 40% in growth within several years, mostly due to broader enrollment and increased use during and after the pandemic.
Recent federal budget measures under the Trump administration have included sizable proposed cuts to federal Medicaid contributions and changed rules around program structure. Notably, the “One Big Beautiful Bill Act,” adopted in 2025, is estimated to reduce federal Medicaid funding by more than $1 trillion over 10 years. The law adds new work requirements and increased cost-sharing, which could restrict coverage and lower available funding for some recipients. Such moves are likely to shift additional costs to the states and restrict the expansion of federal Medicaid support, even as the program continues serving tens of millions across the country.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $901,313 | 16.1% |
| 2021 | $439,616 | -51.2% |
| 2022 | $121,566 | -72.3% |
| 2023 | $178,067 | 46.5% |
| 2024 | $228,481 | 28.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $2,427,782 | 70.1% |
| 2 | Medicine Services and Procedures | $351,641 | 10.2% |
| 3 | Alcohol and Drug Abuse Treatment | $276,475 | 8% |
| 4 | Evaluation and Management | $228,481 | 6.6% |
| 5 | Procedures / Professional Services | $124,483 | 3.6% |
| 6 | Pathology and Laboratory Procedures | $37,288 | 1.1% |
| 7 | Ambulance and Other Transport Services and Supplies | $4,974 | 0.1% |
| 8 | Radiology Procedures | $4,559 | 0.1% |
| 9 | Surgery | $3,900 | 0.1% |
| 10 | Dental Services | $2,386 | 0.1% |
| 11 | Drugs Administered Other than Oral Method | $1,432 | <0.1% |
| 12 | Coronavirus Diagnostic Panel | $229 | <0.1% |
| 13 | Temporary Codes | $217 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99282 | Emergency dept visit sf mdm | $70,605 | 23 |
| 99283 | Emergency dept visit low mdm | $60,295 | 13 |
| 99213 | Office o/p est low 20 min | $45,541 | 12 |
| 99284 | Emergency dept visit mod mdm | $29,010 | 7 |
| 99214 | Office o/p est mod 30 min | $13,307 | 11 |
| 99204 | Office o/p new mod 45 min | $1,807 | 9 |
| 99396 | Prev visit est age 40-64 | $1,515 | 9 |
| 99395 | Prev visit est age 18-39 | $1,412 | 8 |
| 99394 | Prev visit est age 12-17 | $1,162 | 7 |
| 99202 | Office o/p new sf 15 min | $978 | 1 |
| 99393 | Prev visit est age 5-11 | $756 | 7 |
| 99203 | Office o/p new low 30 min | $731 | 8 |
| 99212 | Office o/p est sf 10 min | $661 | 9 |
| 99392 | Prev visit est age 1-4 | $492 | 5 |
| 99384 | Prev visit new age 12-17 | $201 | 1 |
| 99215 | Office o/p est hi 40 min | $0 | 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.
