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 |
|---|---|---|---|---|
| Chippewa Falls, WI | $31.70 | $3.65 – $67.94 | 53,287 | 70 |
| Westerly, RI | $37.19 | $0.02 – $93.30 | 53,303 | 65 |
| Henryetta, OK | $75.39 | $0.00 – $181.15 | 53,312 | 13 |
| Liberty Township, OH | $47.03 | $12.39 – $318.75 | 53,324 | 46 |
| Fort Edward, NY | $58.68 | $48.18 – $86.26 | 53,375 | 9 |
| Camas, WA | $61.25 | $15.45 – $140.93 | 53,416 | 29 |
| Tavares, FL | $43.19 | $0.00 – $204.42 | 53,492 | 57 |
| Eagle, ID | $68.69 | $0.64 – $216.59 | 53,578 | 57 |
| Park Rapids, MN | $153.01 | $15.55 – $187.71 | 53,592 | 42 |
| Aledo, TX | $52.84 | $8.74 – $81.35 | 53,775 | 11 |
| La Canada, CA | $3.98 | $0.00 – $67.13 | 53,886 | 15 |
| Hazlehurst, MS | $43.31 | $13.07 – $56.78 | 53,898 | 13 |
| Chanute, KS | $64.38 | $0.00 – $209.70 | 53,934 | 30 |
| Duson, LA | $10.88 | $0.00 – $38.98 | 53,947 | 5 |
| Abington, MA | $50.99 | $6.81 – $104.18 | 53,976 | 15 |
| Palmview, TX | $42.35 | $0.00 – $127.98 | 54,004 | 5 |
| Struthers, OH | $45.64 | $19.26 – $96.84 | 54,005 | 9 |
| Bishop, CA | $13.26 | $0.00 – $217.24 | 54,026 | 33 |
| West Hempstead, NY | $77.40 | $0.70 – $256.21 | 54,184 | 31 |
| Brewster, WA | $57.97 | $1.51 – $92.96 | 54,255 | 28 |
| Iola, KS | $112.61 | $2.39 – $221.03 | 54,353 | 18 |
| Apple Valley, MN | $82.13 | $0.00 – $362.97 | 54,359 | 99 |
| Natick, MA | $53.94 | $0.48 – $105.92 | 54,401 | 60 |
| Salida, CO | $94.62 | $15.75 – $252.44 | 54,430 | 48 |
| Friendswood, TX | $57.66 | $11.21 – $253.21 | 54,541 | 35 |
| San Bruno, CA | $18.04 | $0.00 – $1,746 | 54,566 | 19 |
| Waynesburg, PA | $42.73 | $0.00 – $75.79 | 54,566 | 27 |
| Farmingdale, NY | $69.07 | $13.85 – $210.63 | 54,678 | 23 |
| Middletown, RI | $59.22 | $0.00 – $202.49 | 54,686 | 80 |
| Franklin, MA | $47.02 | $8.65 – $138.77 | 54,691 | 50 |
| Lavale, MD | $57.01 | $1.70 – $114.96 | 54,693 | 21 |
| Wellsville, NY | $76.05 | $19.06 – $116.35 | 54,698 | 33 |
| Clinton, IL | $31.61 | $0.00 – $101.50 | 54,760 | 11 |
| Chagrin Falls, OH | $37.50 | $9.97 – $61.19 | 54,768 | 32 |
| Holbrook, NY | $113.42 | $36.34 – $165.01 | 54,815 | 25 |
| Oradell, NJ | $42.51 | $8.66 – $70.12 | 54,841 | 12 |
| Waycross, GA | $52.41 | $5.78 – $107.84 | 54,848 | 28 |
| Mukilteo, WA | $57.79 | $1.11 – $99.77 | 54,880 | 40 |
| Quakertown, PA | $50.11 | $1.87 – $132.84 | 54,882 | 60 |
| Hamilton, AL | $25.81 | $0.00 – $225.27 | 54,888 | 20 |
| Stow, OH | $37.29 | $17.63 – $100.46 | 54,890 | 49 |
| Albion, NY | $65.17 | $28.37 – $148.67 | 54,890 | 15 |
| Irvington, AL | $4.02 | $0.00 – $42.21 | 54,960 | 17 |
| Aguas Buenas, PR | $1.09 | $0.00 – $6.08 | 55,009 | 15 |
| Randolph, MA | $56.21 | $5.12 – $122.28 | 55,015 | 30 |
| Morton, IL | $53.98 | $5.87 – $81.18 | 55,017 | 34 |
| Canby, OR | $72.42 | $24.21 – $152.89 | 55,021 | 30 |
| Gouverneur, NY | $86.80 | $2.77 – $171.89 | 55,059 | 13 |
| Deltona, FL | $42.75 | $0.00 – $123.71 | 55,073 | 45 |
| Springvale, ME | $3.83 | $0.00 – $63.35 | 55,097 | 8 |
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.