Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Brooklyn, NY | $71.20 | $0.00 – $550.20 | 32,336,840 | 5588 |
| New York, NY | $81.86 | $0.00 – $835.87 | 23,551,154 | 7530 |
| Los Angeles, CA | $24.20 | $0.00 – $1,261 | 16,948,065 | 5565 |
| Chicago, IL | $30.31 | $0.00 – $695.30 | 13,989,780 | 5801 |
| Bronx, NY | $82.40 | $0.00 – $294.47 | 13,626,712 | 3705 |
| Phoenix, AZ | $47.53 | $0.00 – $654.00 | 13,269,420 | 4233 |
| Houston, TX | $48.27 | $0.00 – $704.28 | 8,766,644 | 4540 |
| Las Vegas, NV | $54.47 | $0.00 – $455.00 | 8,578,324 | 3512 |
| Columbus, OH | $62.00 | $0.00 – $369.40 | 8,388,006 | 3806 |
| Bakersfield, CA | $46.07 | $0.00 – $964.45 | 7,411,940 | 1316 |
| Fresno, CA | $9.04 | $0.00 – $2,215 | 7,118,942 | 1290 |
| Flushing, NY | $73.08 | $0.00 – $221.40 | 7,013,594 | 850 |
| Baltimore, MD | $85.10 | $0.00 – $688.45 | 6,638,810 | 3443 |
| Louisville, KY | $41.24 | $0.00 – $868.43 | 6,565,945 | 3179 |
| San Diego, CA | $33.35 | $0.00 – $1,655 | 6,429,225 | 2910 |
| Cincinnati, OH | $57.26 | $0.00 – $479.75 | 6,244,164 | 3656 |
| Philadelphia, PA | $47.22 | $0.00 – $1,022 | 5,853,067 | 4673 |
| Indianapolis, IN | $63.89 | $0.00 – $345.00 | 5,827,043 | 3759 |
| Boston, MA | $84.37 | $0.00 – $436.16 | 5,683,879 | 4776 |
| Sacramento, CA | $22.28 | $0.00 – $1,190 | 5,640,528 | 2066 |
| Baton Rouge, LA | $42.02 | $0.00 – $366.17 | 5,521,275 | 1713 |
| Tucson, AZ | $46.43 | $0.00 – $577.64 | 5,463,316 | 2390 |
| Milwaukee, WI | $50.47 | $0.00 – $300.00 | 5,280,772 | 2369 |
| New Orleans, LA | $36.79 | $0.00 – $631.17 | 4,998,945 | 1957 |
| Miami, FL | $49.15 | $0.00 – $642.42 | 4,998,845 | 2828 |
| Cleveland, OH | $41.74 | $0.00 – $318.75 | 4,839,931 | 3568 |
| Detroit, MI | $56.69 | $0.00 – $428.16 | 4,680,416 | 517 |
| San Antonio, TX | $47.25 | $0.00 – $719.00 | 4,471,070 | 2424 |
| Washington, DC | $76.54 | $0.00 – $607.91 | 4,461,887 | 2656 |
| San Francisco, CA | $27.38 | $0.00 – $1,531 | 4,381,925 | 2602 |
| Lexington, KY | $40.42 | $0.00 – $472.55 | 4,343,155 | 2144 |
| Nashville, TN | $46.51 | $0.00 – $566.63 | 4,188,840 | 2789 |
| San Jose, CA | $17.76 | $0.00 – $1,683 | 4,087,517 | 1112 |
| Albuquerque, NM | $72.81 | $0.00 – $872.73 | 3,965,435 | 2586 |
| Charlotte, NC | $61.85 | $0.00 – $827.92 | 3,946,873 | 2854 |
| Memphis, TN | $39.77 | $0.00 – $353.72 | 3,737,410 | 1657 |
| Dallas, TX | $47.45 | $0.00 – $937.10 | 3,693,999 | 1988 |
| Denver, CO | $89.80 | $0.00 – $671.04 | 3,664,561 | 2164 |
| Riverside, CA | $33.28 | $0.00 – $2,827 | 3,628,375 | 1030 |
| Knoxville, TN | $45.18 | $0.00 – $232.03 | 3,462,740 | 1776 |
| Shreveport, LA | $44.74 | $0.00 – $263.31 | 3,418,347 | 1092 |
| Rochester, NY | $80.81 | $0.00 – $532.82 | 3,372,720 | 2362 |
| Grand Rapids, MI | $56.03 | $0.00 – $695.81 | 3,306,257 | 314 |
| Portland, OR | $73.00 | $0.00 – $1,356 | 3,294,065 | 3477 |
| Dearborn, MI | $66.33 | $0.00 – $129.78 | 3,194,505 | 244 |
| Seattle, WA | $64.74 | $0.00 – $784.86 | 3,147,175 | 3468 |
| San Juan, PR | $18.99 | $0.00 – $590.91 | 3,140,039 | 1050 |
| Orlando, FL | $66.63 | $0.00 – $1,030 | 3,037,031 | 1866 |
| Dayton, OH | $64.03 | $0.00 – $384.54 | 3,013,507 | 1213 |
| Oakland, CA | $19.22 | $0.00 – $949.89 | 2,992,452 | 1231 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.