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 |
|---|---|---|---|---|
| Plainville, MA | $54.68 | $6.42 – $103.09 | 62,235 | 38 |
| Euless, TX | $43.04 | $6.79 – $56.79 | 62,260 | 26 |
| North Conway, NH | $45.36 | $3.17 – $198.11 | 62,283 | 53 |
| Richland, GA | $108.04 | $100.85 – $110.85 | 62,304 | 2 |
| Edmonton, KY | $34.76 | $25.79 – $43.27 | 62,307 | 10 |
| Orocovis, PR | $2.22 | $0.00 – $107.39 | 62,375 | 15 |
| New Castle, DE | $46.76 | $0.00 – $141.47 | 62,390 | 31 |
| Howell, MI | $142.81 | $0.00 – $237.02 | 62,391 | 19 |
| Orosi, CA | $11.56 | $0.00 – $21.48 | 62,405 | 16 |
| Wartburg, TN | $36.28 | $14.82 – $64.03 | 62,413 | 21 |
| Conyers, GA | $51.27 | $1.51 – $163.33 | 62,445 | 52 |
| Vandalia, OH | $51.15 | $23.99 – $100.19 | 62,523 | 48 |
| Vinton, IA | $11.70 | $0.00 – $58.64 | 62,531 | 19 |
| Eastman, GA | $78.10 | $14.70 – $105.52 | 62,590 | 10 |
| Bomoseen, VT | $7.07 | $1.32 – $49.88 | 62,680 | 23 |
| Wauchula, FL | $35.38 | $0.00 – $174.91 | 62,692 | 22 |
| Rahway, NJ | $48.36 | $0.00 – $112.50 | 62,714 | 27 |
| Temperance, MI | $7.86 | $0.00 – $86.88 | 62,726 | 8 |
| Quincy, CA | $28.84 | $0.00 – $715.09 | 62,730 | 17 |
| Hoopa, CA | $1.28 | $0.01 – $34.80 | 62,771 | 4 |
| Painesville, OH | $34.91 | $12.06 – $59.73 | 62,804 | 30 |
| Mecca, CA | $5.35 | $0.00 – $33.72 | 62,826 | 11 |
| Lagrange, GA | $48.00 | $0.00 – $509.03 | 62,866 | 66 |
| Trenton, MI | $71.74 | $23.26 – $112.56 | 62,902 | 22 |
| Lowville, NY | $66.01 | $26.43 – $209.98 | 62,978 | 38 |
| East Cleveland, OH | $32.32 | $0.60 – $44.56 | 62,994 | 17 |
| Winchester, IN | $60.95 | $31.76 – $188.65 | 63,016 | 23 |
| Blythe, CA | $20.06 | $0.00 – $959.85 | 63,048 | 16 |
| Baker City, OR | $44.84 | $0.00 – $123.37 | 63,064 | 44 |
| Berlin, NH | $16.28 | $0.00 – $100.72 | 63,107 | 43 |
| Lithia, FL | $57.18 | $7.60 – $143.14 | 63,134 | 31 |
| New Albany, OH | $48.87 | $3.64 – $111.37 | 63,180 | 53 |
| Walker, LA | $39.50 | $14.63 – $49.64 | 63,256 | 19 |
| Panama City Beach, FL | $34.11 | $0.00 – $147.19 | 63,315 | 27 |
| Oxford, MI | $104.63 | $56.77 – $136.75 | 63,323 | 7 |
| Venice, FL | $46.34 | $0.00 – $400.75 | 63,365 | 80 |
| East Hampton, NY | $101.72 | $49.70 – $110.34 | 63,386 | 9 |
| Louisville, CO | $66.59 | $0.00 – $669.33 | 63,406 | 43 |
| Mauston, WI | $42.50 | $0.00 – $75.56 | 63,426 | 42 |
| Wagoner, OK | $70.32 | $13.19 – $109.87 | 63,462 | 28 |
| Kaysville, UT | $49.66 | $1.18 – $78.43 | 63,482 | 19 |
| Bellevue, OH | $39.58 | $23.12 – $118.45 | 63,502 | 26 |
| Spanaway, WA | $54.48 | $0.00 – $67.43 | 63,600 | 23 |
| Hillsborough, NC | $67.62 | $21.77 – $100.99 | 63,609 | 51 |
| Quebradillas, PR | $4.72 | $0.00 – $47.27 | 63,646 | 27 |
| Glen Ridge, NJ | $59.64 | $6.84 – $140.31 | 63,655 | 36 |
| Rye Brook, NY | $106.03 | $25.73 – $152.51 | 63,693 | 14 |
| Gulf Breeze, FL | $57.31 | $0.00 – $145.39 | 63,713 | 41 |
| Marina, CA | $41.09 | $0.00 – $682.60 | 63,783 | 23 |
| Pomeroy, OH | $44.06 | $0.54 – $82.03 | 63,847 | 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.