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 |
|---|---|---|---|---|
| Jena, LA | $7.76 | $0.00 – $23.61 | 97,710 | 15 |
| Latrobe, PA | $42.98 | $0.72 – $89.91 | 97,728 | 68 |
| North Adams, MA | $74.51 | $1.69 – $359.15 | 97,735 | 40 |
| Lake Station, IN | $53.39 | $43.28 – $67.03 | 97,758 | 10 |
| Lawrenceburg, KY | $27.57 | $15.77 – $65.21 | 97,916 | 26 |
| Newberg, OR | $68.73 | $8.00 – $617.40 | 98,104 | 96 |
| Newton, KS | $100.11 | $0.00 – $406.18 | 98,138 | 56 |
| Parsons, KS | $110.12 | $0.00 – $174.03 | 98,163 | 32 |
| Oneonta, NY | $95.64 | $10.34 – $135.20 | 98,169 | 65 |
| Plano, IL | $53.74 | $46.21 – $59.40 | 98,175 | 6 |
| Menomonee Falls, WI | $34.92 | $0.00 – $84.61 | 98,190 | 135 |
| Capitola, CA | $44.76 | $0.00 – $145.03 | 98,204 | 43 |
| Ellensburg, WA | $45.03 | $4.89 – $135.93 | 98,221 | 68 |
| Zionsville, IN | $66.24 | $3.07 – $207.72 | 98,372 | 65 |
| Flushing, MI | $51.76 | $30.25 – $72.22 | 98,435 | 5 |
| Maricopa, AZ | $61.12 | $0.00 – $113.90 | 98,439 | 40 |
| Willingboro, NJ | $68.94 | $8.63 – $215.38 | 98,455 | 55 |
| Cumberland, KY | $32.09 | $12.95 – $49.74 | 98,467 | 10 |
| Big Stone Gap, VA | $57.62 | $23.34 – $111.24 | 98,523 | 28 |
| Great Bend, KS | $137.09 | $0.00 – $267.27 | 98,576 | 55 |
| Waynesboro, VA | $61.03 | $24.40 – $93.82 | 98,588 | 56 |
| Oak Hill, WV | $18.88 | $0.00 – $89.83 | 98,629 | 43 |
| Oro Valley, AZ | $66.76 | $0.05 – $516.19 | 98,640 | 62 |
| Elmwood Park, NJ | $64.24 | $0.00 – $124.00 | 98,685 | 19 |
| Murphysboro, IL | $6.71 | $0.00 – $59.61 | 98,697 | 16 |
| Coralville, IA | $41.87 | $0.00 – $101.03 | 98,832 | 100 |
| Clarkston, WA | $34.23 | $1.03 – $191.34 | 98,870 | 39 |
| Greenbrae, CA | $70.32 | $0.00 – $538.43 | 98,872 | 62 |
| Wildomar, CA | $31.37 | $0.00 – $229.15 | 98,875 | 43 |
| Gansevoort, NY | $59.84 | $5.76 – $103.54 | 98,977 | 32 |
| Mechanicsburg, PA | $69.27 | $0.00 – $661.01 | 98,988 | 114 |
| Middleburg, FL | $51.74 | $0.00 – $90.31 | 99,041 | 48 |
| Hoover, AL | $59.24 | $0.00 – $107.15 | 99,219 | 64 |
| Milford, MA | $64.98 | $1.63 – $211.10 | 99,229 | 110 |
| Claremore, OK | $111.23 | $0.00 – $653.19 | 99,255 | 66 |
| St Clair Shores, MI | $61.25 | $36.02 – $68.70 | 99,255 | 6 |
| Olney, MD | $89.41 | $0.00 – $164.70 | 99,366 | 69 |
| Manistee, MI | $68.53 | $1.01 – $353.20 | 99,394 | 18 |
| Watertown, MA | $73.13 | $0.00 – $136.75 | 99,439 | 53 |
| Chesterfield, MO | $63.08 | $5.44 – $318.46 | 99,458 | 122 |
| Hackettstown, NJ | $49.50 | $0.00 – $115.11 | 99,466 | 53 |
| Batesville, MS | $59.72 | $0.00 – $156.35 | 99,474 | 52 |
| Westport, CT | $48.73 | $0.00 – $143.12 | 99,486 | 78 |
| Kaneohe, HI | $38.51 | $0.00 – $287.69 | 99,564 | 45 |
| Guayanilla, PR | $4.53 | $0.00 – $35.98 | 99,623 | 14 |
| Huntingdon, TN | $36.82 | $10.53 – $57.24 | 99,637 | 30 |
| Sequim, WA | $34.50 | $0.31 – $436.51 | 99,708 | 72 |
| Dresden, TN | $27.97 | $12.59 – $46.20 | 99,917 | 16 |
| Bryan, TX | $45.46 | $0.00 – $227.63 | 99,937 | 103 |
| Brookfield, WI | $34.06 | $0.00 – $133.35 | 99,961 | 130 |
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.