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 |
|---|---|---|---|---|
| White Plains, MD | $91.94 | $0.00 – $137.06 | 52,094 | 37 |
| Marshall, MO | $50.82 | $20.10 – $113.10 | 52,153 | 40 |
| Chevy Chase, MD | $66.79 | $0.00 – $170.79 | 52,180 | 73 |
| Los Fresnos, TX | $37.33 | $33.75 – $37.45 | 52,211 | 3 |
| Dexter, MO | $73.93 | $13.44 – $155.72 | 52,221 | 28 |
| Salem, KY | $29.35 | $13.38 – $42.92 | 52,254 | 18 |
| Greenacres, FL | $30.33 | $0.08 – $592.12 | 52,282 | 30 |
| King Of Prussia, PA | $51.77 | $6.22 – $153.72 | 52,287 | 52 |
| Newport, RI | $59.78 | $17.80 – $163.23 | 52,343 | 51 |
| Sewickley, PA | $49.62 | $0.00 – $130.00 | 52,358 | 70 |
| Sand Springs, OK | $82.87 | $4.87 – $117.62 | 52,364 | 26 |
| Apex, NC | $56.37 | $9.21 – $133.66 | 52,380 | 42 |
| Fairfield Township, OH | $48.43 | $32.47 – $119.19 | 52,380 | 26 |
| Laguna Niguel, CA | $51.74 | $0.00 – $113.31 | 52,406 | 25 |
| Sitka, AK | $292.95 | $0.00 – $859.58 | 52,419 | 28 |
| Hudson, WI | $33.99 | $14.13 – $86.50 | 52,435 | 64 |
| Madras, OR | $34.62 | $0.00 – $388.49 | 52,442 | 24 |
| Vernon Rockville, CT | $71.47 | $6.79 – $76.72 | 52,480 | 5 |
| Decatur, IN | $49.60 | $21.19 – $77.45 | 52,517 | 37 |
| Jonesborough, TN | $39.60 | $15.04 – $65.33 | 52,520 | 10 |
| East Islip, NY | $62.53 | $1.13 – $112.22 | 52,525 | 20 |
| Parlin, NJ | $46.81 | $23.33 – $57.21 | 52,528 | 9 |
| Cypress, CA | $26.70 | $0.00 – $179.64 | 52,611 | 27 |
| Hamburg, NY | $56.33 | $0.00 – $116.34 | 52,649 | 47 |
| Yardley, PA | $47.10 | $0.00 – $109.09 | 52,697 | 69 |
| Harrison, NJ | $54.34 | $1.10 – $116.24 | 52,706 | 11 |
| Erin, TN | $41.92 | $33.20 – $51.85 | 52,707 | 10 |
| Jamestown, ND | $92.48 | $0.00 – $427.76 | 52,722 | 48 |
| Halfmoon, NY | $79.62 | $5.34 – $107.94 | 52,732 | 38 |
| Plainsboro, NJ | $36.75 | $0.00 – $168.15 | 52,773 | 38 |
| Sandy, UT | $78.31 | $0.35 – $185.79 | 52,777 | 75 |
| Lake Ronkonkoma, NY | $69.68 | $3.20 – $104.81 | 52,835 | 20 |
| Grand Bay, AL | $3.43 | $2.85 – $70.88 | 52,849 | 4 |
| Philippi, WV | $10.86 | $0.00 – $78.91 | 52,873 | 21 |
| Aurora, IN | $55.95 | $31.51 – $80.73 | 52,880 | 13 |
| Riverview, MI | $74.10 | $34.45 – $94.64 | 52,910 | 12 |
| Sebastopol, CA | $7.29 | $0.00 – $75.30 | 52,976 | 31 |
| Cedar Springs, MI | $6.72 | $4.72 – $6.75 | 53,014 | 2 |
| Flower Mound, TX | $44.68 | $0.00 – $344.18 | 53,014 | 51 |
| Fountain, CO | $131.67 | $0.00 – $230.20 | 53,057 | 21 |
| Winterville, NC | $63.57 | $7.99 – $75.86 | 53,092 | 11 |
| Leland, NC | $58.57 | $0.00 – $167.04 | 53,104 | 49 |
| Linden, TN | $28.92 | $6.54 – $50.50 | 53,117 | 17 |
| Fridley, MN | $82.17 | $13.18 – $277.89 | 53,120 | 93 |
| Mayfield Village, OH | $34.73 | $17.75 – $69.47 | 53,125 | 23 |
| Plainwell, MI | $10.25 | $3.42 – $70.82 | 53,138 | 2 |
| Ridgeway, VA | $59.66 | $0.00 – $73.23 | 53,141 | 9 |
| Roslindale, MA | $81.57 | $4.55 – $109.75 | 53,205 | 21 |
| Bothell, WA | $46.90 | $0.00 – $115.97 | 53,247 | 76 |
| Ellsworth, ME | $42.72 | $2.28 – $402.95 | 53,263 | 56 |
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.