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 |
|---|---|---|---|---|
| Natrona Heights, PA | $59.92 | $1.60 – $81.65 | 50,531 | 49 |
| Rochelle Park, NJ | $63.53 | $9.56 – $177.01 | 50,535 | 14 |
| Maple Heights, OH | $30.91 | $16.70 – $65.14 | 50,553 | 11 |
| Orrville, OH | $32.09 | $2.04 – $97.86 | 50,627 | 28 |
| Valley, AL | $59.86 | $0.00 – $215.29 | 50,629 | 21 |
| Drexel Hill, PA | $34.61 | $0.10 – $109.00 | 50,645 | 49 |
| Mayfield Heights, OH | $44.98 | $9.10 – $314.31 | 50,648 | 60 |
| Shelby, MT | $16.91 | $0.00 – $644.22 | 50,706 | 14 |
| Plainfield, CT | $54.11 | $0.59 – $81.88 | 50,712 | 17 |
| Hardinsburg, KY | $36.15 | $0.00 – $57.48 | 50,781 | 17 |
| Del City, OK | $54.17 | $4.01 – $112.53 | 50,818 | 23 |
| Soddy Daisy, TN | $42.10 | $19.34 – $61.95 | 50,827 | 20 |
| Charlestown, MA | $47.25 | $0.00 – $183.13 | 50,833 | 44 |
| Martin, KY | $29.66 | $10.77 – $43.09 | 50,880 | 15 |
| Sandy Hook, KY | $33.93 | $0.00 – $41.81 | 50,894 | 9 |
| Bryson City, NC | $62.19 | $0.00 – $505.49 | 50,899 | 12 |
| Niceville, FL | $53.07 | $0.00 – $86.85 | 51,146 | 27 |
| Estero, FL | $53.45 | $0.00 – $130.50 | 51,178 | 37 |
| Mustang, OK | $85.50 | $22.15 – $634.48 | 51,185 | 23 |
| Shelby, MI | $4.98 | $3.37 – $60.27 | 51,202 | 4 |
| Sharon, PA | $16.82 | $0.00 – $118.12 | 51,231 | 27 |
| Saint Marys, WV | $58.97 | $0.79 – $81.61 | 51,232 | 18 |
| New Paltz, NY | $85.90 | $8.39 – $111.10 | 51,252 | 23 |
| Saint Croix Falls, WI | $36.41 | $13.05 – $71.78 | 51,313 | 40 |
| Port Deposit, MD | $90.78 | $90.68 – $125.43 | 51,332 | 2 |
| Union Springs, AL | $2.73 | $0.00 – $177.73 | 51,355 | 7 |
| Elmwood Park, IL | $60.98 | $0.00 – $134.05 | 51,363 | 22 |
| Williamston, NC | $52.48 | $0.00 – $95.40 | 51,393 | 16 |
| Oldsmar, FL | $80.46 | $1.90 – $175.00 | 51,395 | 11 |
| Zebulon, NC | $70.21 | $10.59 – $88.31 | 51,439 | 20 |
| River Forest, IL | $51.39 | $0.00 – $171.70 | 51,506 | 30 |
| Bath, NY | $79.58 | $0.00 – $141.72 | 51,509 | 29 |
| Haledon, NJ | $53.64 | $0.00 – $94.77 | 51,540 | 9 |
| Belzoni, MS | $69.79 | $0.00 – $123.29 | 51,590 | 10 |
| Ferndale, WA | $35.85 | $5.05 – $83.89 | 51,674 | 22 |
| Garwood, NJ | $47.92 | $0.36 – $244.15 | 51,698 | 4 |
| Saco, ME | $38.29 | $4.03 – $99.87 | 51,702 | 52 |
| Saint Francisville, LA | $25.19 | $0.00 – $72.21 | 51,715 | 9 |
| Greenville, PA | $45.32 | $0.00 – $86.50 | 51,731 | 26 |
| Whitehall, PA | $34.23 | $0.00 – $106.55 | 51,749 | 23 |
| Lagrange, IN | $52.18 | $10.75 – $102.95 | 51,760 | 26 |
| Pataskala, OH | $35.66 | $20.69 – $64.35 | 51,839 | 22 |
| Cottonwood, CA | $4.86 | $1.11 – $85.97 | 51,881 | 5 |
| Pittsford, NY | $70.29 | $0.00 – $474.33 | 51,966 | 55 |
| Dennison, OH | $53.76 | $0.00 – $98.52 | 51,985 | 16 |
| Pearl, MS | $78.19 | $1.02 – $134.63 | 52,007 | 29 |
| Newton, MA | $45.68 | $0.00 – $180.25 | 52,016 | 102 |
| Woodbridge, NJ | $42.31 | $0.00 – $85.24 | 52,052 | 26 |
| South Haven, MI | $14.66 | $3.55 – $65.54 | 52,053 | 7 |
| Glenwood Springs, CO | $120.63 | $0.00 – $351.00 | 52,060 | 60 |
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.