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 |
|---|---|---|---|---|
| Newman, CA | $16.73 | $0.00 – $129.54 | 83,514 | 13 |
| Port Jefferson, NY | $94.30 | $0.00 – $169.40 | 83,543 | 85 |
| Zion, IL | $27.49 | $0.11 – $108.37 | 83,585 | 27 |
| Timonium, MD | $101.92 | $0.00 – $729.53 | 83,685 | 48 |
| Willmar, MN | $85.69 | $19.79 – $214.42 | 83,688 | 95 |
| Henrico, VA | $63.09 | $5.99 – $190.51 | 83,729 | 79 |
| Fremont, MI | $6.40 | $0.00 – $42.98 | 83,782 | 8 |
| Webster, NY | $66.41 | $0.00 – $135.22 | 83,812 | 68 |
| Livingston, MT | $10.29 | $0.00 – $917.12 | 83,827 | 25 |
| Martinsville, IN | $64.69 | $15.74 – $110.21 | 83,847 | 26 |
| Grayling, MI | $26.53 | $11.90 – $84.16 | 83,853 | 9 |
| Crest Hill, IL | $50.88 | $23.70 – $70.95 | 83,858 | 25 |
| Tarrytown, NY | $98.18 | $3.99 – $146.77 | 83,867 | 35 |
| Lexington, MA | $63.79 | $2.82 – $151.66 | 83,870 | 50 |
| Eastvale, CA | $8.95 | $0.00 – $93.91 | 83,910 | 20 |
| New Roads, LA | $8.54 | $0.00 – $76.60 | 83,934 | 23 |
| Newport, VT | $11.75 | $0.00 – $109.28 | 83,944 | 47 |
| Carroll, IA | $39.03 | $0.00 – $68.98 | 83,965 | 44 |
| Clarion, PA | $50.21 | $0.01 – $104.25 | 84,155 | 35 |
| Lutz, FL | $56.68 | $0.00 – $719.00 | 84,177 | 71 |
| Marlborough, MA | $49.24 | $0.83 – $121.78 | 84,284 | 54 |
| Inverness, FL | $34.70 | $0.00 – $128.54 | 84,290 | 50 |
| Talihina, OK | $502.37 | $87.72 – $719.00 | 84,394 | 57 |
| Lebanon, MO | $59.06 | $3.08 – $153.35 | 84,514 | 65 |
| Englewood Cliffs, NJ | $39.71 | $20.37 – $195.47 | 84,516 | 36 |
| The Dalles, OR | $48.21 | $0.00 – $147.36 | 84,523 | 73 |
| Bluffton, IN | $60.50 | $11.70 – $102.06 | 84,641 | 38 |
| Highlands Ranch, CO | $77.62 | $4.20 – $198.77 | 84,765 | 94 |
| Sleepy Hollow, NY | $98.78 | $0.00 – $204.95 | 84,789 | 61 |
| Liberal, KS | $47.99 | $0.00 – $197.72 | 84,803 | 30 |
| Cortez, CO | $175.97 | $0.00 – $640.00 | 84,856 | 66 |
| Norcross, GA | $59.90 | $6.77 – $89.92 | 84,895 | 21 |
| Fort Madison, IA | $35.47 | $0.00 – $338.53 | 84,935 | 44 |
| Schererville, IN | $63.30 | $10.64 – $85.36 | 84,942 | 37 |
| St Johnsbury, VT | $14.72 | $0.00 – $316.61 | 84,989 | 66 |
| Milpitas, CA | $7.53 | $0.00 – $176.40 | 85,063 | 62 |
| Port Barre, LA | $6.56 | $0.00 – $39.75 | 85,083 | 10 |
| Flatwoods, KY | $31.41 | $10.74 – $43.80 | 85,093 | 17 |
| Manhattan Beach, CA | $5.07 | $0.00 – $174.91 | 85,114 | 34 |
| Sparta, NJ | $58.72 | $0.00 – $92.13 | 85,200 | 33 |
| Bingham Farms, MI | $68.72 | $4.88 – $156.83 | 85,247 | 21 |
| Pennington Gap, VA | $57.45 | $9.79 – $398.45 | 85,306 | 13 |
| Turnersville, NJ | $46.96 | $0.00 – $150.96 | 85,338 | 63 |
| Allegan, MI | $38.55 | $1.36 – $193.01 | 85,347 | 9 |
| Mamou, LA | $21.85 | $0.00 – $56.64 | 85,360 | 14 |
| West Bridgewater, MA | $42.03 | $0.00 – $70.88 | 85,374 | 17 |
| Gautier, MS | $24.38 | $0.00 – $87.50 | 85,384 | 13 |
| South Holland, IL | $43.09 | $0.00 – $234.53 | 85,408 | 38 |
| Emporia, KS | $115.97 | $0.00 – $182.44 | 85,418 | 48 |
| Burlington, WI | $33.95 | $0.00 – $68.44 | 85,505 | 86 |
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.