In 2024, Medicaid providers in Calexico submitted $2,331,216 in claims for services categorized as Evaluation and Management, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 12.9% rise over the prior year, when $2,064,460 in claims were filed for the same category.
Medicaid is a joint federal and state public health insurance program. It serves low-income individuals and families, seniors, children, and people with disabilities, making it a key element of the U.S. healthcare infrastructure. Funding is provided by both federal and state governments.
Since Medicaid funding is sourced from taxpayers, any changes in local billing reflect how public health care spending is distributed within a community.
The “Evaluation and Management” category encompasses a range of Medicaid-billed services defined by types of care, organized using standardized HCPCS and CPT code groups. For this report, each billing code was assigned to a single service category based on consistent prefixes and numerical ranges, which helps group related services, prevent double counting, and maintain accurate rankings.
While overall Medicaid spending increased across several service lines, Evaluation and Management was the second-highest category for Medicaid payments in Calexico in 2024.
Statewide in California, Evaluation and Management was also the second-ranking category by Medicaid payment total in 2024.
Looking at the five years before 2024, Calexico saw Medicaid payments for Evaluation and Management rise by $1,292,108, a 124.3% jump. Growth rates picked up during specific intervals, with significant year-over-year increases tracked in both 2023 and 2022.
Spending on Evaluation and Management care was not evenly distributed throughout Calexico, with payments largely concentrated in a few ZIP codes. During 2024, ZIP code 92231 alone accounted for $2,331,215 in Medicaid payments under this category, meaning the top ZIP code represented 100% of such payments for the city that year.
Within the Evaluation and Management group, Medicaid payments were additionally focused among only a handful of specific billing codes.
When comparing Medicaid payments for Evaluation and Management in Calexico, there was a 12.9% increase between 2024 and 2023, while all Medicaid claim categories in the city posted an 8.5% rise in that period.
Centers for Medicare & Medicaid Services data show that combined state and federal Medicaid spending reached about $871.7 billion in fiscal year 2023. This amount made up around 18% of all national health spending, a significant climb from $613.5 billion in 2019 before the COVID-19 pandemic.
The change represents an increase of roughly 40% over several years, driven chiefly by larger enrollments and greater usage during and after the pandemic period.
Federal budget legislation from the Trump administration has included major proposals to decrease federal Medicaid funding and change the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid outlays by more than $1 trillion over the next 10 years and introduce work requirements and higher cost-sharing measures that could impact some beneficiaries’ coverage. These provisions are anticipated to shift greater costs to states and limit federal growth, even as the program continues to support millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,039,107 | -6.2% |
| 2021 | $1,044,976 | 0.6% |
| 2022 | $1,171,820 | 12.1% |
| 2023 | $2,064,459 | 76.2% |
| 2024 | $2,331,215 | 12.9% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $8,887,517 | 50.9% |
| 2 | Evaluation and Management | $2,331,215 | 13.3% |
| 3 | Medicine Services and Procedures | $2,149,278 | 12.3% |
| 4 | Alcohol and Drug Abuse Treatment | $2,006,628 | 11.5% |
| 5 | Temporary National Codes (Non-Medicare) | $1,152,392 | 6.6% |
| 6 | Procedures / Professional Services | $484,778 | 2.8% |
| 7 | Ambulance and Other Transport Services and Supplies | $221,666 | 1.3% |
| 8 | Dental Services | $185,393 | 1.1% |
| 9 | Pathology and Laboratory Procedures | $28,369 | 0.2% |
| 10 | Surgery | $11,006 | 0.1% |
| 11 | Medical And Surgical Supplies | $8,803 | 0.1% |
| 12 | Radiology Procedures | $555 | <0.1% |
| 13 | Drugs Administered Other than Oral Method | $80 | <0.1% |
| 14 | Anesthesia | $0 | <0.1% |
| 14 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99214 | Office o/p est mod 30 min | $1,639,426 | 227 |
| 99213 | Office o/p est low 20 min | $388,309 | 350 |
| 99215 | Office o/p est hi 40 min | $133,072 | 29 |
| 99396 | Prev visit est age 40-64 | $48,491 | 38 |
| 99212 | Office o/p est sf 10 min | $28,829 | 76 |
| 98960 | Edu&trn pt self-mgmt nqhp 1 | $18,449 | 6 |
| 99203 | Office o/p new low 30 min | $18,277 | 46 |
| 99204 | Office o/p new mod 45 min | $14,030 | 20 |
| 99392 | Prev visit est age 1-4 | $7,051 | 23 |
| 99395 | Prev visit est age 18-39 | $6,125 | 27 |
| 99393 | Prev visit est age 5-11 | $4,318 | 24 |
| 99391 | Per pm reeval est pat infant | $4,087 | 22 |
| 99394 | Prev visit est age 12-17 | $3,736 | 24 |
| 99490 | Chrnc care mgmt staff 1st 20 | $3,599 | 9 |
| 99188 | App topical fluoride varnish | $3,551 | 20 |
| 99493 | Sbsq psyc collab care mgmt | $3,496 | 2 |
| 99211 | Off/op est may x req phy/qhp | $1,567 | 24 |
| 99483 | Assmt & care pln pt cog imp | $1,319 | 1 |
| 99381 | Init pm e/m new pat infant | $1,032 | 9 |
| 99457 | Rpm tx mgmt 1st 20 min | $1,022 | 6 |
Note: HCPCS codes are provided for additional context within this category. Totals and rankings cited in this article rely on grouped service categories rather than individual billing codes.
Data for this article was sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original data set is available here.
