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 |
|---|---|---|---|---|
| Arden, NC | $69.39 | $0.00 – $644.18 | 88,053 | 91 |
| Reisterstown, MD | $105.26 | $0.45 – $229.02 | 88,075 | 48 |
| The Villages, FL | $40.30 | $0.00 – $174.14 | 88,155 | 111 |
| Naugatuck, CT | $42.68 | $0.00 – $85.58 | 88,205 | 32 |
| Shinnston, WV | $68.79 | $39.66 – $69.38 | 88,229 | 4 |
| Saratoga Springs, UT | $11.86 | $6.24 – $85.83 | 88,275 | 19 |
| Redmond, WA | $50.42 | $4.53 – $185.13 | 88,279 | 100 |
| Garden City, KS | $51.53 | $0.00 – $183.35 | 88,295 | 66 |
| Granbury, TX | $46.41 | $0.00 – $188.50 | 88,344 | 71 |
| Walterboro, SC | $68.92 | $0.00 – $186.21 | 88,390 | 33 |
| Astoria, OR | $30.98 | $0.13 – $136.54 | 88,392 | 69 |
| Urbana, OH | $37.29 | $0.82 – $88.07 | 88,442 | 39 |
| Azusa, CA | $19.24 | $0.00 – $644.75 | 88,479 | 24 |
| Okmulgee, OK | $86.38 | $19.33 – $626.04 | 88,481 | 24 |
| Carlinville, IL | $11.54 | $0.00 – $79.98 | 88,490 | 16 |
| Newtown, CT | $40.94 | $0.00 – $75.72 | 88,639 | 39 |
| Gloucester, MA | $41.95 | $0.00 – $80.44 | 88,661 | 30 |
| Trussville, AL | $78.58 | $24.64 – $101.62 | 88,711 | 16 |
| Seymour, TN | $49.80 | $10.40 – $473.38 | 88,857 | 35 |
| Vega Alta, PR | $9.41 | $0.00 – $103.42 | 88,873 | 38 |
| Powderly, KY | $32.63 | $14.96 – $42.38 | 88,971 | 25 |
| Freeport, IL | $52.21 | $11.78 – $118.66 | 88,996 | 56 |
| Firebaugh, CA | $12.57 | $0.00 – $25.08 | 89,010 | 11 |
| North Brunswick, NJ | $43.98 | $0.00 – $173.25 | 89,151 | 40 |
| Bear, DE | $58.48 | $0.00 – $130.52 | 89,252 | 32 |
| Franklin, NC | $59.04 | $0.00 – $507.14 | 89,381 | 41 |
| Choctaw, MS | $377.02 | $0.00 – $472.79 | 89,458 | 5 |
| Ranson, WV | $65.71 | $6.87 – $89.50 | 89,592 | 26 |
| Tishomingo, OK | $183.75 | $0.00 – $719.00 | 89,599 | 39 |
| New Kensington, PA | $40.75 | $0.00 – $86.70 | 89,607 | 21 |
| Brazil, IN | $56.15 | $7.46 – $122.11 | 89,608 | 28 |
| Brewton, AL | $53.46 | $0.00 – $198.10 | 89,697 | 30 |
| Chesterfield, MI | $63.06 | $18.39 – $69.60 | 89,730 | 9 |
| Lake Providence, LA | $0.01 | $0.00 – $0.09 | 89,771 | 12 |
| Mansfield, LA | $2.43 | $0.00 – $71.15 | 89,808 | 12 |
| Superior, WI | $26.15 | $0.00 – $234.61 | 89,816 | 47 |
| Lordsburg, NM | $213.01 | $63.37 – $214.06 | 89,855 | 3 |
| New Tazewell, TN | $35.11 | $12.70 – $60.71 | 89,870 | 24 |
| Rohnert Park, CA | $3.80 | $0.00 – $54.08 | 89,899 | 37 |
| Diamond Bar, CA | $37.33 | $0.00 – $119.63 | 89,934 | 45 |
| Post Falls, ID | $47.13 | $-0.78 – $105.48 | 90,012 | 104 |
| Saint Charles, MO | $59.08 | $0.00 – $254.31 | 90,016 | 102 |
| Massapequa, NY | $60.67 | $0.00 – $138.28 | 90,025 | 78 |
| Hermitage, PA | $42.72 | $0.00 – $94.03 | 90,032 | 76 |
| Sullivan, MO | $53.57 | $2.55 – $210.81 | 90,058 | 40 |
| Phillipsburg, NJ | $43.59 | $0.00 – $131.17 | 90,294 | 78 |
| Waxahachie, TX | $30.03 | $0.00 – $83.35 | 90,335 | 47 |
| West Chester, PA | $52.44 | $0.00 – $109.48 | 90,357 | 129 |
| Moorpark, CA | $13.09 | $0.00 – $340.86 | 90,357 | 33 |
| Elma, WA | $48.43 | $0.00 – $228.12 | 90,440 | 35 |
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.