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 |
|---|---|---|---|---|
| Salem, MO | $64.05 | $0.64 – $126.27 | 35,878 | 17 |
| Maywood, NJ | $71.06 | $25.96 – $131.39 | 35,945 | 18 |
| Kingsburg, CA | $6.75 | $0.05 – $19.95 | 35,947 | 14 |
| Summit, WI | $32.41 | $0.00 – $52.37 | 35,949 | 58 |
| Commerce Township, MI | $64.24 | $18.05 – $100.74 | 36,022 | 9 |
| Guthrie, OK | $82.57 | $60.70 – $139.49 | 36,022 | 19 |
| Indiantown, FL | $41.27 | $4.50 – $43.08 | 36,034 | 5 |
| Berea, OH | $63.63 | $18.38 – $315.73 | 36,059 | 22 |
| Thompsons Station, TN | $44.65 | $6.03 – $91.48 | 36,069 | 23 |
| Blairsville, PA | $52.75 | $8.05 – $75.28 | 36,095 | 19 |
| Buffalo, MN | $71.60 | $3.35 – $187.84 | 36,123 | 68 |
| Harold, KY | $33.03 | $19.73 – $54.80 | 36,149 | 9 |
| Corsicana, TX | $42.80 | $0.00 – $494.51 | 36,152 | 38 |
| Godfrey, IL | $23.17 | $0.01 – $68.94 | 36,160 | 13 |
| Blaine, MN | $71.01 | $13.00 – $118.66 | 36,184 | 60 |
| Goldendale, WA | $32.70 | $0.00 – $189.57 | 36,202 | 8 |
| Havertown, PA | $38.08 | $0.00 – $113.03 | 36,207 | 52 |
| Highland, IL | $33.29 | $0.00 – $71.64 | 36,227 | 21 |
| Orinda, CA | $6.65 | $0.00 – $94.14 | 36,251 | 25 |
| Walton, NY | $121.49 | $2.15 – $169.24 | 36,268 | 22 |
| Cromwell, CT | $42.00 | $0.00 – $88.21 | 36,297 | 28 |
| Aurora, MO | $68.09 | $5.07 – $157.19 | 36,306 | 19 |
| Centreville, MI | $65.56 | $4.16 – $172.42 | 36,314 | 4 |
| Collegeville, PA | $32.27 | $0.00 – $74.68 | 36,328 | 43 |
| Saranac Lake, NY | $92.59 | $0.00 – $122.21 | 36,334 | 34 |
| Dillon, MT | $35.77 | $0.00 – $883.21 | 36,342 | 18 |
| West Jefferson, NC | $64.69 | $37.46 – $68.35 | 36,351 | 6 |
| Sahuarita, AZ | $49.57 | $0.02 – $66.59 | 36,355 | 13 |
| Arcadia, LA | $2.86 | $0.00 – $30.21 | 36,380 | 5 |
| Vidalia, GA | $67.02 | $5.46 – $917.90 | 36,391 | 13 |
| Bordentown, NJ | $63.06 | $1.24 – $140.37 | 36,404 | 34 |
| Draper, UT | $58.52 | $11.12 – $230.91 | 36,422 | 42 |
| Mountain Home, ID | $19.90 | $0.20 – $103.21 | 36,423 | 24 |
| Loris, SC | $78.86 | $14.54 – $174.43 | 36,451 | 31 |
| Hillsville, VA | $59.46 | $13.58 – $113.79 | 36,475 | 15 |
| Johns Creek, GA | $70.81 | $0.00 – $135.45 | 36,485 | 26 |
| Rich, VA | $62.40 | $62.40 – $62.40 | 36,515 | 1 |
| Somers, NY | $80.02 | $4.56 – $210.24 | 36,578 | 17 |
| Plainview, TX | $27.89 | $0.00 – $74.74 | 36,600 | 26 |
| Cranford, NJ | $52.73 | $7.96 – $106.20 | 36,601 | 21 |
| Somerset, PA | $40.65 | $4.00 – $154.43 | 36,611 | 41 |
| Rancho Palos Verdes, CA | $3.96 | $0.00 – $123.41 | 36,649 | 14 |
| Sandy, OR | $78.38 | $54.05 – $159.97 | 36,657 | 29 |
| Waimanalo, HI | $125.42 | $19.46 – $304.88 | 36,667 | 12 |
| Enosburg Falls, VT | $17.00 | $0.41 – $26.88 | 36,674 | 9 |
| Chavies, KY | $34.88 | $28.57 – $40.34 | 36,708 | 2 |
| Merrick, NY | $70.74 | $0.00 – $157.72 | 36,716 | 29 |
| Melrose, MA | $52.79 | $5.32 – $449.47 | 36,750 | 47 |
| Pedro, OH | $27.96 | $0.00 – $121.53 | 36,786 | 26 |
| Evergreen, CO | $71.79 | $15.03 – $199.60 | 36,800 | 25 |
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.