In 2024, Medicaid providers in Fontana submitted claims totaling $32,613,241 for services included in the Evaluation and Management category, as shown in the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amounted to a 134.1% jump from 2023, when claims for the same services reached $13,932,930.
Medicaid, a state-administered public health insurance program with federal and state funding, covers groups including low-income individuals, families, seniors, children, and people with disabilities. Its scope makes it one of the largest components in the U.S. health care system. More on its funding source can be found here.
Since Medicaid payouts are funded by taxpayers, shifts in local billing totals provide insight into how public health funds are allocated within the community.
The Evaluation and Management category consolidates Medicaid-billed services identified by type of care, grouped under standardized HCPCS and CPT code ranges. For this analysis, each billing code was included in a single service category using set code prefixes and numeric groupings, which helps combine related services, avoid overlap, and keep rankings reliable across different periods.
While several service categories saw increases in Medicaid spending, Evaluation and Management led in total Medicaid payments in Fontana for 2024.
In California, Evaluation and Management ranked as the state’s second largest service category by total Medicaid payments in 2024.
Looking at the five years before 2024, Medicaid payments linked to the Evaluation and Management category in Fontana grew by $26,450,729, an increase of 429.2%. Some periods experienced sharper growth, including notable year-to-year rises in 2020 and 2021.
Spending for Evaluation and Management care took place throughout Fontana but was concentrated in a few ZIP codes. In 2024, the 92335 ZIP code had $28,977,412 in payments, 92336 recorded $3,634,477, and 92337 registered $1,350. These 3 ZIP codes represented all Medicaid payments for the Evaluation and Management category in Fontana in 2024.
Most Medicaid payments within the Evaluation and Management category focused on a small selection of billing codes.
Comparatively, Medicaid payments associated with Evaluation and Management in Fontana increased by 134.1% from 2023 to 2024. Across all Medicaid claim categories in the city, the overall increase was 93% over that period.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid expenditures reached about $871.7 billion in fiscal year 2023. This represented roughly 18% of total national health care spending, up from approximately $613.5 billion in 2019 before the COVID-19 emergency.
The roughly 40% gain over those years largely resulted from expanded enrollment and an increase in service utilization during and after the pandemic.
Recent federal budget legislation under the Trump administration included major initiatives to reduce federal Medicaid funding and change the program’s structure. The “One Big Beautiful Bill Act,” which became law in 2025, is expected to cut more than $1 trillion in federal Medicaid spending over the coming decade and introduces new work requirements along with more cost-sharing, potentially narrowing both coverage and funding for some recipients. These policies are anticipated to shift additional financial responsibility to states while placing limits on the growth of federal assistance as Medicaid remains a source of coverage for millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $6,162,512 | 102.1% |
| 2021 | $8,848,349 | 43.6% |
| 2022 | $10,805,375 | 22.1% |
| 2023 | $13,932,930 | 28.9% |
| 2024 | $32,613,240 | 134.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $32,613,240 | 37.6% |
| 2 | Medicine Services and Procedures | $17,697,242 | 20.4% |
| 3 | Radiology Procedures | $11,177,097 | 12.9% |
| 4 | Dental Services | $6,359,275 | 7.3% |
| 5 | National Codes Established for State Medicaid Agencies | $4,951,032 | 5.7% |
| 6 | Pathology and Laboratory Procedures | $4,905,714 | 5.7% |
| 7 | Temporary National Codes (Non-Medicare) | $2,722,400 | 3.1% |
| 8 | Procedures / Professional Services | $2,334,188 | 2.7% |
| 9 | Ambulance and Other Transport Services and Supplies | $1,988,256 | 2.3% |
| 10 | Surgery | $959,461 | 1.1% |
| 11 | Drugs Administered Other than Oral Method | $444,031 | 0.5% |
| 12 | Anesthesia | $354,515 | 0.4% |
| 13 | Administrative, Miscellaneous and Investigational | $93,197 | 0.1% |
| 14 | Temporary Codes | $54,924 | 0.1% |
| 15 | Medical And Surgical Supplies | $47,865 | 0.1% |
| 16 | Vision Services | $26,336 | <0.1% |
| 17 | Chemotherapy Drugs | $23,244 | <0.1% |
| 18 | Alcohol and Drug Abuse Treatment | $15,604 | <0.1% |
| 19 | Pathology and Laboratory Services | $15,171 | <0.1% |
| 20 | Outpatient PPS | $97 | <0.1% |
| 21 | Other Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99283 | Emergency dept visit low mdm | $12,672,262 | 227 |
| 99214 | Office o/p est mod 30 min | $6,437,602 | 3,564 |
| 99284 | Emergency dept visit mod mdm | $6,066,379 | 794 |
| 99213 | Office o/p est low 20 min | $1,789,063 | 2,354 |
| 99291 | Critical care first hour | $1,407,863 | 13 |
| 99282 | Emergency dept visit sf mdm | $871,211 | 19 |
| 99203 | Office o/p new low 30 min | $568,615 | 196 |
| 99212 | Office o/p est sf 10 min | $546,610 | 1,199 |
| 99204 | Office o/p new mod 45 min | $476,146 | 219 |
| 99285 | Emergency dept visit hi mdm | $245,681 | 50 |
| 99215 | Office o/p est hi 40 min | $210,221 | 109 |
| 99391 | Per pm reeval est pat infant | $200,920 | 359 |
| 99392 | Prev visit est age 1-4 | $183,577 | 445 |
| 99393 | Prev visit est age 5-11 | $175,859 | 367 |
| 99202 | Office o/p new sf 15 min | $89,213 | 118 |
| 99441 | $86,190 | 106 | |
| 99394 | Prev visit est age 12-17 | $80,601 | 192 |
| 99442 | $79,362 | 59 | |
| 99443 | $60,774 | 31 | |
| 99238 | Hosp ip/obs dschrg mgmt 30/< | $33,502 | 41 |
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.
