In 2024, Medicaid providers in La Verne billed a total of $379,533 for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 32% increase from 2023, when providers filed $287,454 in claims for the same category of service.
Medicaid is a government-run health insurance program supported through federal and state funding. It serves low-income individuals and families, seniors, children, and people with disabilities, making it one of the core elements of the U.S. health system.
Because taxpayer money funds Medicaid, fluctuations in local billing patterns reflect how community health care dollars are spent.
The Evaluation and Management category groups services based on care type, with classification set according to standardized HCPCS and CPT code groupings. Each billing code was placed into a single service group for this review, using specific code prefixes and number ranges. This approach keeps related services together and ensures no duplicative counts or errors in ranking over time.
Among all service categories, Evaluation and Management received the highest total Medicaid payments in La Verne in 2024.
Statewide in California, Evaluation and Management ranked as the second largest category by Medicaid payments in 2024.
Over the five-year period before 2024, Medicaid payments linked to Evaluation and Management in La Verne grew by $243,333, or 178.7%. Growth accelerated during specific years, with notable increases in both 2022 and 2021.
While Evaluation and Management payments were spread throughout the city, the highest concentration occurred in specific ZIP codes. In 2024, ZIP code 91750 received all $379,533 in Evaluation and Management Medicaid payments, representing 100% of the city’s total for this category.
Payments in the Evaluation and Management group also centered on a small number of billing codes.
To compare, La Verne saw a 32% rise in Evaluation and Management Medicaid payments between 2024 and 2023, whereas all claim categories saw a 50.6% change citywide during the same time frame.
The Centers for Medicare & Medicaid Services reports that combined federal and state Medicaid spending was about $871.7 billion in the 2023 fiscal year. This made up approximately 18% of total national health expenditures and reflects a significant rise from roughly $613.5 billion in 2019, prior to the COVID-19 pandemic.
This nearly 40% increase over several years is mainly due to expanded program enrollment and higher service use during and after the pandemic.
Recent national budget laws from the Trump administration include substantial proposals to decrease federal Medicaid funding and alter the program structure. One example, the “One Big Beautiful Bill Act,” signed into law in 2025, is expected to reduce federal Medicaid spending by over $1 trillion over 10 years. It introduces policies such as work requirements and more cost-sharing, which could lead to less coverage and reduced funding for some people. These measures are likely to shift more costs to states and slow the growth of federal Medicaid support, even as the program continues to serve many Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $136,200 | -8.9% |
| 2021 | $179,761 | 32% |
| 2022 | $242,804 | 35.1% |
| 2023 | $287,454 | 18.4% |
| 2024 | $379,533 | 32% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $379,533 | 27.8% |
| 2 | Enteral and Parenteral Therapy | $370,512 | 27.1% |
| 3 | Pathology and Laboratory Procedures | $317,689 | 23.3% |
| 4 | Dental Services | $85,888 | 6.3% |
| 5 | Ambulance and Other Transport Services and Supplies | $77,162 | 5.6% |
| 6 | Temporary National Codes (Non-Medicare) | $65,940 | 4.8% |
| 7 | Medicine Services and Procedures | $50,981 | 3.7% |
| 8 | Vision Services | $9,289 | 0.7% |
| 9 | Durable Medical Equipment | $4,233 | 0.3% |
| 10 | Diagnostic Radiology Services | $2,716 | 0.2% |
| 11 | Procedures / Professional Services | $1,337 | 0.1% |
| 12 | Temporary Codes | $339 | <0.1% |
| 13 | Pathology and Laboratory Services | $297 | <0.1% |
| 14 | Radiology Procedures | $239 | <0.1% |
| 15 | Surgery | $147 | <0.1% |
| 16 | Drugs Administered Other than Oral Method | $10 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $4 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $250,482 | 140 |
| 99203 | Office o/p new low 30 min | $52,440 | 43 |
| 99214 | Office o/p est mod 30 min | $49,026 | 51 |
| 99215 | Office o/p est hi 40 min | $13,426 | 11 |
| 99306 | 1st nf care high mdm 50 | $7,946 | 7 |
| 99212 | Office o/p est sf 10 min | $3,010 | 3 |
| 99308 | Sbsq nf care low mdm 20 | $2,789 | 7 |
| 99000 | Specimen handling office-lab | $177 | 3 |
| 99204 | Office o/p new mod 45 min | $165 | 1 |
| 99173 | Visual acuity screen | $67 | 2 |
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.
