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 |
|---|---|---|---|---|
| Granite Falls, NC | $44.32 | $25.52 – $77.29 | 105,555 | 24 |
| Westford, MA | $56.69 | $1.45 – $137.93 | 105,623 | 47 |
| Scarborough, ME | $47.95 | $0.82 – $251.99 | 105,667 | 184 |
| Marinette, WI | $38.84 | $0.00 – $59.95 | 105,680 | 82 |
| Imperial Beach, CA | $8.76 | $0.19 – $114.05 | 105,705 | 21 |
| Los Lunas, NM | $79.99 | $0.47 – $122.69 | 105,742 | 44 |
| Rochester, IN | $55.43 | $25.47 – $75.43 | 105,757 | 30 |
| Mount Pleasant, MI | $48.15 | $16.20 – $114.13 | 105,782 | 17 |
| Brockport, NY | $60.99 | $11.67 – $136.83 | 105,827 | 43 |
| Lewisburg, WV | $24.91 | $0.00 – $87.72 | 105,861 | 77 |
| Denver, NC | $65.52 | $31.89 – $87.22 | 105,912 | 49 |
| Newark, NY | $63.86 | $14.75 – $114.84 | 106,069 | 54 |
| Darien, CT | $45.99 | $0.00 – $108.25 | 106,101 | 53 |
| Amherst, MA | $55.01 | $2.08 – $112.81 | 106,118 | 60 |
| Camp Hill, PA | $52.01 | $0.00 – $184.42 | 106,120 | 137 |
| Fruitland, ID | $47.84 | $5.76 – $502.77 | 106,169 | 44 |
| North Augusta, SC | $58.34 | $0.00 – $142.19 | 106,261 | 46 |
| Prosser, WA | $37.27 | $6.82 – $102.67 | 106,279 | 45 |
| Gilroy, CA | $14.27 | $0.00 – $1,394 | 106,295 | 57 |
| Manitowoc, WI | $32.19 | $0.00 – $65.36 | 106,498 | 93 |
| Miami Gardens, FL | $19.81 | $0.00 – $115.84 | 106,655 | 30 |
| Conover, NC | $52.16 | $12.12 – $79.63 | 106,735 | 41 |
| Taft, CA | $27.84 | $0.00 – $291.03 | 106,945 | 16 |
| South Boston, MA | $94.44 | $0.00 – $137.78 | 107,080 | 26 |
| Olney, IL | $12.26 | $0.00 – $125.00 | 107,135 | 33 |
| Madison, TN | $33.97 | $3.23 – $114.16 | 107,200 | 48 |
| Granada Hills, CA | $77.64 | $0.00 – $1,097 | 107,301 | 38 |
| Owingsville, KY | $35.97 | $0.00 – $48.91 | 107,317 | 20 |
| Miami, OK | $76.46 | $0.57 – $347.94 | 107,388 | 53 |
| Tamarac, FL | $53.03 | $0.27 – $304.03 | 107,449 | 69 |
| Grove, OK | $88.71 | $18.54 – $149.95 | 107,525 | 41 |
| Alamo, TX | $39.91 | $13.37 – $71.15 | 107,607 | 12 |
| Watertown, SD | $43.16 | $19.58 – $208.73 | 107,626 | 20 |
| Hudson, NY | $86.08 | $2.71 – $148.07 | 107,634 | 64 |
| Arroyo Grande, CA | $25.52 | $0.00 – $461.51 | 107,676 | 39 |
| Mullins, SC | $53.58 | $17.55 – $166.81 | 107,881 | 27 |
| Arvada, CO | $81.33 | $0.00 – $252.78 | 107,910 | 93 |
| Crow Agency, MT | $1.75 | $0.33 – $591.60 | 107,912 | 6 |
| Kenton, OH | $37.72 | $0.00 – $91.83 | 107,962 | 34 |
| Hope Mills, NC | $51.23 | $0.00 – $84.48 | 108,030 | 19 |
| Summit, NJ | $59.31 | $0.00 – $199.57 | 108,125 | 102 |
| Plainview, NY | $75.59 | $2.29 – $205.70 | 108,239 | 100 |
| Blackfoot, ID | $16.72 | $-14.08 – $141.43 | 108,261 | 57 |
| Polson, MT | $12.60 | $0.00 – $137.49 | 108,416 | 32 |
| Tinley Park, IL | $52.02 | $10.34 – $159.33 | 108,517 | 87 |
| Elkton, KY | $34.01 | $0.00 – $49.05 | 108,554 | 24 |
| Carencro, LA | $34.37 | $0.00 – $80.92 | 108,843 | 23 |
| Galloway, NJ | $45.96 | $0.12 – $123.83 | 108,855 | 64 |
| Maynardville, TN | $48.66 | $17.50 – $71.66 | 109,013 | 18 |
| Cedar Park, TX | $36.69 | $0.00 – $134.09 | 109,031 | 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.