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 |
|---|---|---|---|---|
| Kingston, TN | $34.25 | $8.12 – $87.78 | 56,426 | 18 |
| Bulls Gap, TN | $32.66 | $2.32 – $45.30 | 56,467 | 10 |
| Sacramentto, CA | $0.48 | $0.48 – $0.48 | 56,581 | 1 |
| La Verne, CA | $30.77 | $0.00 – $321.56 | 56,662 | 23 |
| Hillsborough, NJ | $55.45 | $0.00 – $307.58 | 56,710 | 56 |
| Dublin, GA | $49.98 | $3.17 – $150.91 | 56,719 | 29 |
| Elkhorn, WI | $32.73 | $9.75 – $64.23 | 56,728 | 48 |
| Wyandanch, NY | $64.73 | $42.38 – $113.28 | 56,759 | 7 |
| Center Valley, PA | $54.85 | $6.67 – $109.35 | 56,778 | 46 |
| Adelanto, CA | $5.82 | $0.98 – $644.22 | 56,803 | 9 |
| Pella, IA | $30.07 | $0.00 – $69.79 | 56,804 | 62 |
| Huntingdon Valley, PA | $33.06 | $0.00 – $67.25 | 56,822 | 31 |
| Florence, MA | $45.58 | $0.00 – $110.06 | 56,833 | 53 |
| Eagle River, AK | $100.44 | $0.00 – $605.23 | 56,835 | 47 |
| East Longmeadow, MA | $56.65 | $3.60 – $70.78 | 56,974 | 23 |
| Glenville, NY | $76.56 | $38.59 – $109.74 | 56,975 | 11 |
| Kihei, HI | $58.67 | $9.14 – $274.86 | 57,035 | 32 |
| Kittanning, PA | $42.97 | $0.00 – $141.83 | 57,120 | 50 |
| Covington, GA | $63.35 | $6.20 – $108.67 | 57,125 | 46 |
| Port Orange, FL | $39.98 | $0.00 – $166.78 | 57,130 | 53 |
| Newton, MS | $83.53 | $14.19 – $138.05 | 57,132 | 19 |
| Trevose, PA | $47.68 | $0.00 – $89.33 | 57,151 | 16 |
| Alice, TX | $19.86 | $7.49 – $551.88 | 57,179 | 31 |
| Round Lake Beach, IL | $32.41 | $0.20 – $99.71 | 57,190 | 11 |
| Centreville, VA | $57.95 | $0.00 – $99.68 | 57,319 | 46 |
| Abingdon, MD | $83.66 | $17.29 – $192.31 | 57,332 | 31 |
| Greensburg, LA | $22.79 | $0.00 – $35.31 | 57,363 | 13 |
| Monett, MO | $65.89 | $0.72 – $127.94 | 57,493 | 40 |
| Collins, MS | $91.30 | $0.00 – $232.81 | 57,547 | 21 |
| Fairport, NY | $67.84 | $25.75 – $114.85 | 57,548 | 33 |
| Lake Forest, CA | $34.19 | $1.29 – $916.70 | 57,597 | 28 |
| Cortland, OH | $41.97 | $15.95 – $88.39 | 57,611 | 21 |
| El Dorado, KS | $47.45 | $0.00 – $79.27 | 57,668 | 31 |
| Waller, TX | $33.47 | $7.60 – $42.50 | 57,670 | 7 |
| Mullica Hill, NJ | $37.03 | $1.73 – $101.86 | 57,670 | 37 |
| Bedford, OH | $50.76 | $6.41 – $124.74 | 57,676 | 24 |
| Livermore, CA | $6.20 | $0.00 – $133.44 | 57,687 | 36 |
| Schertz, TX | $47.36 | $8.05 – $104.04 | 57,737 | 44 |
| Hampstead, NC | $58.08 | $15.48 – $92.44 | 57,755 | 29 |
| Lamar, CO | $143.22 | $31.89 – $312.58 | 57,787 | 29 |
| Pine Ridge, SD | $366.25 | $0.00 – $370.14 | 57,804 | 5 |
| Essex, CT | $53.12 | $0.00 – $174.57 | 57,852 | 30 |
| Homewood, IL | $57.71 | $11.61 – $318.75 | 57,877 | 27 |
| Roslyn, NY | $92.98 | $0.00 – $205.75 | 57,913 | 48 |
| Pennsauken, NJ | $34.38 | $6.06 – $79.24 | 57,929 | 24 |
| Syosset, NY | $81.46 | $6.99 – $225.77 | 57,994 | 51 |
| Newhall, CA | $19.54 | $0.00 – $111.88 | 58,087 | 21 |
| Stayton, OR | $37.73 | $6.03 – $98.76 | 58,101 | 35 |
| Tucker, GA | $36.09 | $3.25 – $168.00 | 58,121 | 32 |
| Proctorville, OH | $38.91 | $1.07 – $72.64 | 58,128 | 15 |
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.