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 |
|---|---|---|---|---|
| Westchester, IL | $53.09 | $11.73 – $290.59 | 29,022 | 18 |
| Heber Springs, AR | $35.99 | $0.00 – $111.88 | 29,023 | 22 |
| Lynwood, IL | $37.65 | $0.01 – $105.09 | 29,024 | 4 |
| Essexville, MI | $54.50 | $38.12 – $89.44 | 29,026 | 9 |
| Silver Creek, NY | $50.26 | $28.31 – $131.67 | 29,027 | 7 |
| Lawndale, CA | $23.86 | $0.00 – $101.55 | 29,046 | 23 |
| Rensselaer, NY | $64.32 | $36.12 – $98.77 | 29,080 | 39 |
| West Chicago, IL | $0.00 | $0.00 – $0.00 | 29,088 | 1 |
| Elizabethtown, NC | $56.93 | $9.75 – $96.85 | 29,088 | 14 |
| Camden, OH | $38.88 | $33.13 – $63.65 | 29,090 | 4 |
| Calhoun, LA | $12.66 | $0.00 – $48.46 | 29,101 | 8 |
| Huron, CA | $1.62 | $0.00 – $2.98 | 29,102 | 5 |
| West Milford, WV | $3.67 | $0.01 – $39.52 | 29,119 | 10 |
| Deville, LA | $9.25 | $2.93 – $16.12 | 29,129 | 4 |
| New London, NH | $37.79 | $1.52 – $251.55 | 29,130 | 26 |
| Branchburg, NJ | $43.55 | $18.24 – $83.59 | 29,141 | 17 |
| Farmington, UT | $68.28 | $25.37 – $99.26 | 29,146 | 20 |
| Mora, MN | $93.66 | $17.20 – $173.01 | 29,156 | 38 |
| Winters, CA | $6.16 | $0.00 – $30.05 | 29,157 | 8 |
| Pollocksville, NC | $43.67 | $22.06 – $122.75 | 29,169 | 18 |
| Meadville, MS | $70.85 | $20.89 – $125.10 | 29,186 | 10 |
| Playa Vista, CA | $6.29 | $0.00 – $66.10 | 29,193 | 11 |
| Hope, IN | $52.17 | $13.34 – $65.33 | 29,202 | 10 |
| La Jara, CO | $161.57 | $49.86 – $271.25 | 29,219 | 7 |
| Jerome, ID | $8.98 | $0.00 – $60.68 | 29,231 | 19 |
| Malden, MO | $97.61 | $30.76 – $144.62 | 29,239 | 7 |
| Harrington, ME | $4.36 | $0.00 – $800.42 | 29,244 | 4 |
| Oxford, AL | $46.94 | $15.11 – $80.82 | 29,252 | 26 |
| Whitman, MA | $44.29 | $28.64 – $66.21 | 29,279 | 9 |
| Independence, KY | $37.90 | $15.77 – $48.55 | 29,286 | 12 |
| Carpentersville, IL | $1.19 | $0.00 – $56.84 | 29,286 | 2 |
| No Quincy, MA | $2.37 | $1.72 – $2.91 | 29,289 | 2 |
| Hollidaysburg, PA | $51.36 | $2.23 – $82.39 | 29,301 | 15 |
| Charles Town, WV | $59.55 | $12.62 – $144.91 | 29,369 | 13 |
| Winter Springs, FL | $69.37 | $9.79 – $155.98 | 29,391 | 12 |
| West Haverstraw, NY | $69.00 | $56.67 – $85.30 | 29,424 | 4 |
| Tazewell, VA | $57.71 | $15.35 – $80.70 | 29,428 | 17 |
| River Falls, WI | $30.41 | $10.88 – $160.22 | 29,428 | 31 |
| Live Oak, FL | $25.22 | $2.42 – $65.16 | 29,455 | 29 |
| Bonne Terre, MO | $56.14 | $7.93 – $73.64 | 29,456 | 13 |
| Parkersburg, IA | $26.60 | $0.08 – $59.15 | 29,479 | 13 |
| Tinton Falls, NJ | $35.15 | $2.38 – $76.43 | 29,505 | 28 |
| Manchester, PA | $51.65 | $1.05 – $97.96 | 29,515 | 20 |
| Havelock, NC | $55.85 | $20.78 – $82.44 | 29,521 | 17 |
| Franklin, PA | $45.62 | $0.00 – $77.89 | 29,535 | 29 |
| Medford, NJ | $72.15 | $0.00 – $204.22 | 29,546 | 50 |
| Signal Hill, CA | $9.54 | $0.85 – $36.65 | 29,561 | 7 |
| Rainsville, AL | $40.25 | $4.57 – $77.73 | 29,563 | 22 |
| Trezevant, TN | $39.91 | $37.68 – $40.31 | 29,565 | 3 |
| Morgan Hill, CA | $86.44 | $0.00 – $1,568 | 29,574 | 23 |
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.