Medicaid spending for Evaluation and Management services in Irvine reached $7.8 million in 2024

In 2024, providers in Irvine billed Medicaid for $7,786,534 worth of services categorized as Evaluation and Management, U.S. Department of Health and Human Services Medicaid Provider Spending data shows. That figure represents a 35.8% increase from the prior year, when providers filed $5,735,343 in claims in this category.

Medicaid is a public insurance program managed by states in partnership with the federal government and covers low-income individuals, families, seniors, children, and people with disabilities—making it one of the country’s largest health care programs. Funding comes jointly from federal and state sources.

Since Medicaid payments depend on taxpayer funding, shifts in how services are billed locally reflect allocation of public health care dollars in the area.

The Evaluation and Management category includes groups of Medicaid-billed services based on care type, using standardized HCPCS and CPT code groupings. Each billing code was matched to a single category by code prefix and range in this analysis, ensuring related services were grouped while preventing duplication and allowing accurate, year-to-year ranking.

Evaluation and Management was the city’s third-highest category by Medicaid spending in 2024, though Medicaid payments increased across several care types.

At the state level, for California, Evaluation and Management ranked second among all Medicaid service categories in 2024 by total payment.

Between 2019 and 2024, Medicaid payments for Evaluation and Management services in Irvine climbed by $6,113,201, or 365.3%. Some periods saw even faster growth, with significant annual jumps noted in 2021 and 2023.

Although the category accounted for citywide care, much of Irvine’s Medicaid Evaluation and Management spending was concentrated within specific ZIP codes. In 2024, ZIP code 92614 saw $3,461,331 in such payments; 92618 had $1,733,819; and 92604 totaled $1,519,666. These 3 ZIP codes together comprised 86.2% of Irvine’s Evaluation and Management Medicaid expenditures for the year.

Payments were also concentrated in a small set of billing codes within the Evaluation and Management group.

To compare, the increase in Medicaid payments for the Evaluation and Management category in Irvine between 2024 and 2023 was 35.8%, outpacing the 22.4% growth seen across all Medicaid claim types in the city during the same timeframe.

According to the Centers for Medicare & Medicaid Services, combined Medicaid spending from federal and state sources was roughly $871.7 billion in fiscal 2023, accounting for about 18% of national health expenditures—up dramatically from $613.5 billion in 2019, ahead of the COVID-19 pandemic.

The increase, almost 40%, was mostly due to expanded enrollment and higher medical service use during and following the pandemic.

Federal budget measures during the Trump administration introduced major changes for Medicaid, including plans to cut federal funding and modify structuring. As part of this, the “One Big Beautiful Bill Act,” enacted in 2025, is forecasted to trim over $1 trillion from federal Medicaid funding during the next decade. It also brings new requirements such as work policies and increased cost-sharing, which may restrict coverage and reduce funding for some participants. These reforms are expected to place more financial responsibility on states and reduce the growth of federal Medicaid contributions while the program remains vital for tens of millions nationwide.

Note: HCPCS codes are presented for reference within this category. Totals and rankings are based on standardized service groupings, not on individual billing codes.

This article references U.S. Department of Health and Human Services Medicaid Provider Spending data. Source data available here.