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 |
|---|---|---|---|---|
| Arrington, VA | $57.75 | $14.20 – $84.31 | 38,710 | 13 |
| Philipsburg, PA | $20.96 | $0.00 – $223.37 | 38,728 | 21 |
| Bedford, VA | $56.83 | $17.54 – $94.29 | 38,741 | 23 |
| Tumwater, WA | $40.39 | $0.00 – $146.15 | 38,751 | 31 |
| North Richland Hills, TX | $39.45 | $2.24 – $97.04 | 38,771 | 25 |
| Lewisport, KY | $43.44 | $32.09 – $49.76 | 38,832 | 5 |
| Carterville, IL | $4.50 | $0.06 – $42.10 | 38,833 | 11 |
| South Pasadena, CA | $105.41 | $0.00 – $1,149 | 38,890 | 26 |
| Centerville, TN | $34.65 | $0.00 – $51.46 | 38,904 | 14 |
| Washington, NJ | $70.82 | $3.81 – $112.12 | 38,914 | 16 |
| East Wenatchee, WA | $47.16 | $16.33 – $78.19 | 38,938 | 23 |
| Jamestown, NC | $59.28 | $34.40 – $93.71 | 38,968 | 12 |
| Milton, VT | $36.13 | $2.17 – $166.71 | 39,014 | 22 |
| Haddonfield, NJ | $73.32 | $1.12 – $434.87 | 39,020 | 23 |
| Roslyn Heights, NY | $92.28 | $0.00 – $119.53 | 39,024 | 27 |
| North Tonawanda, NY | $57.23 | $6.74 – $98.50 | 39,038 | 27 |
| Barre, VT | $29.77 | $0.00 – $98.02 | 39,041 | 32 |
| Richland Hills, TX | $56.07 | $0.00 – $64.56 | 39,045 | 7 |
| North Plainfield, NJ | $37.20 | $14.79 – $41.05 | 39,048 | 5 |
| Viroqua, WI | $50.06 | $14.16 – $123.63 | 39,073 | 41 |
| West Liberty, OH | $31.02 | $7.27 – $112.88 | 39,227 | 11 |
| Camp Springs, MD | $70.15 | $13.27 – $194.89 | 39,236 | 23 |
| Plymouth, MN | $70.95 | $10.91 – $242.73 | 39,242 | 116 |
| Rockport, TX | $44.83 | $0.00 – $120.49 | 39,293 | 10 |
| Rancho Santa Margarita, CA | $27.18 | $0.00 – $64.46 | 39,314 | 24 |
| Harrisburg, AR | $31.38 | $23.65 – $34.42 | 39,329 | 6 |
| Minocqua, WI | $55.91 | $0.00 – $256.83 | 39,335 | 40 |
| Chelsea, MI | $58.26 | $8.76 – $79.44 | 39,365 | 22 |
| Ruskin, FL | $35.63 | $0.25 – $62.53 | 39,387 | 17 |
| Cameron Park, CA | $76.32 | $7.08 – $600.02 | 39,404 | 28 |
| Andover, MN | $59.19 | $22.30 – $207.44 | 39,417 | 47 |
| Irvington, KY | $34.04 | $21.00 – $38.89 | 39,426 | 5 |
| Campo, CA | $0.94 | $0.00 – $18.54 | 39,452 | 11 |
| Maspeth, NY | $54.89 | $15.74 – $115.77 | 39,481 | 14 |
| Celina, TN | $28.22 | $15.62 – $47.34 | 39,532 | 9 |
| Fulton, AL | $11.71 | $6.78 – $46.12 | 39,573 | 6 |
| Montpelier, VT | $48.78 | $5.03 – $148.46 | 39,578 | 30 |
| Burney, CA | $2.20 | $0.12 – $229.28 | 39,585 | 12 |
| Ardsley, NY | $72.07 | $0.00 – $219.37 | 39,586 | 21 |
| La Junta, CO | $83.85 | $0.00 – $232.03 | 39,618 | 29 |
| Veedersburg, IN | $55.47 | $17.05 – $66.09 | 39,619 | 8 |
| Edgewood, MD | $72.95 | $21.73 – $171.85 | 39,654 | 18 |
| Redway, CA | $1.37 | $0.00 – $1.55 | 39,665 | 4 |
| Mount Shasta, CA | $26.05 | $0.00 – $436.26 | 39,683 | 33 |
| Princeton, ME | $36.45 | $31.13 – $53.85 | 39,695 | 3 |
| Oelwein, IA | $18.66 | $0.00 – $44.43 | 39,702 | 13 |
| Tucumcari, NM | $74.73 | $15.04 – $143.84 | 39,736 | 9 |
| Temple City, CA | $13.72 | $0.00 – $61.50 | 39,790 | 18 |
| Worthington, MN | $113.80 | $3.32 – $246.04 | 39,799 | 43 |
| Grafton, WI | $32.48 | $0.55 – $99.39 | 39,810 | 66 |
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.