Richmond’s Medicaid providers submitted $45,477,067 in claims for Pathology and Laboratory Procedures in 2024, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This reflects a 65.7% rise from the previous year, when $27,441,006 was billed for these services.
Medicaid is a health insurance program administered by states and financed cooperatively by federal and state governments. Serving low-income residents, seniors, children, and those with disabilities, the program is a foundational component of the national health system.
Taxpayer funding for Medicaid means shifts in local spending for these services reflect how community health resources are distributed.
The “Pathology and Laboratory Procedures” classification encompasses a variety of Medicaid services identified by service type, as determined by standardized HCPCS and CPT codes. Billing codes for this analysis were grouped into single service categories by code prefixes and numbers, ensuring consistent analysis without overlap or duplicate counting, and maintaining accurate year-to-year rankings.
Among the major Medicaid categories, Pathology and Laboratory Procedures showed the largest share of total Medicaid payments in Richmond for 2024.
At the state level, Pathology and Laboratory Procedures ranked as the fifth-largest Medicaid category by payments in California in 2024.
Between 2020 and 2024, Medicaid payments related to the Pathology and Laboratory Procedures category in Richmond increased by $18,367,962, or 67.8%. Specific years within this period, including 2021 and 2020, saw especially sharp spending growth.
Although every part of the city received some spending in this category, the largest shares were concentrated in a few ZIP codes. In 2024, ZIP code 94804 accounted for $44,410,634, while ZIP codes 94801 and 94806 received $966,178 and $100,245, respectively. Combined, these top 3 ZIP codes represented 100% of Richmond’s Medicaid payments in the Pathology and Laboratory Procedures category in 2024.
Only a handful of individual billing codes within this category saw the bulk of Medicaid payments.
For reference, the 65.7% jump in Pathology and Laboratory Procedures payments from 2023 to 2024 was outpaced by the 100.1% increase recorded for all Medicaid claim categories citywide over the same period.
Centers for Medicare & Medicaid Services data show combined state and federal Medicaid expenditures reached approximately $871.7 billion for fiscal year 2023, accounting for around 18% of total national health spending—a sharp rise from $613.5 billion in 2019, before the COVID-19 pandemic.
This amounts to around 40% growth in just a few years, mainly due to higher enrollment and usage during and after the pandemic.
Recent federal spending bills under the Trump administration included major proposals to trim federal Medicaid funds and alter the program’s design. The “One Big Beautiful Bill Act,” signed in 2025, is expected to reduce federal Medicaid outlays by over $1 trillion over the next 10 years and adds policies such as work requirements and more cost-sharing, which may limit benefits and funds for some enrollees. These measures are anticipated to increase states’ financial burden and restrain future Medicaid funding growth, even as millions of Americans continue to rely on the program.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $27,109,104 | 14.4% |
| 2021 | $40,386,200 | 49% |
| 2022 | $29,058,318 | -28% |
| 2023 | $27,441,006 | -5.6% |
| 2024 | $45,477,066 | 65.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Pathology and Laboratory Procedures | $45,477,066 | 47.9% |
| 2 | Evaluation and Management | $15,962,903 | 16.8% |
| 3 | Medicine Services and Procedures | $13,707,106 | 14.5% |
| 4 | National Codes Established for State Medicaid Agencies | $7,747,348 | 8.2% |
| 5 | Radiology Procedures | $5,204,644 | 5.5% |
| 6 | Surgery | $3,644,371 | 3.8% |
| 7 | Procedures / Professional Services | $1,153,128 | 1.2% |
| 8 | Alcohol and Drug Abuse Treatment | $926,242 | 1% |
| 9 | Durable Medical Equipment | $289,019 | 0.3% |
| 10 | Ambulance and Other Transport Services and Supplies | $184,816 | 0.2% |
| 11 | Temporary National Codes (Non-Medicare) | $169,760 | 0.2% |
| 12 | Drugs Administered Other than Oral Method | $145,971 | 0.2% |
| 13 | Medical And Surgical Supplies | $123,503 | 0.1% |
| 14 | Dental Services | $85,783 | 0.1% |
| 15 | Administrative, Miscellaneous and Investigational | $18,399 | <0.1% |
| 16 | Temporary Codes | $1,653 | <0.1% |
| 17 | Anesthesia | $1,062 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 81420 | Fetal chrmoml aneuploidy | $11,615,718 | 17 |
| 82105 | Alpha-fetoprotein serum | $6,448,972 | 31 |
| 84443 | Assay thyroid stim hormone | $3,094,770 | 29 |
| 83036 | Hemoglobin glycosylated a1c | $2,564,254 | 55 |
| 80061 | Lipid panel | $1,978,254 | 28 |
| 82306 | Vitamin d 25 hydroxy | $1,526,713 | 23 |
| 82565 | Assay of creatinine | $1,366,827 | 45 |
| 80307 | Drug test prsmv chem anlyzr | $1,179,202 | 16 |
| 82728 | Assay of ferritin | $1,009,987 | 24 |
| 84460 | Alanine amino (alt) (sgpt) | $941,726 | 41 |
| 85025 | Complete cbc w/auto diff wbc | $926,766 | 37 |
| 83970 | Assay of parathormone | $824,082 | 14 |
| 85027 | Complete cbc automated | $817,647 | 27 |
| 82607 | Vitamin b-12 | $787,659 | 12 |
| 88305 | Tissue exam by pathologist | $721,807 | 337 |
| 84132 | Assay of serum potassium | $719,447 | 33 |
| 84153 | Assay of psa total | $540,257 | 14 |
| 83550 | Iron binding test | $462,232 | 23 |
| 80051 | Electrolyte panel | $415,572 | 33 |
| 84450 | Transferase (ast) (sgot) | $370,127 | 35 |
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.
