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 |
|---|---|---|---|---|
| Santee, CA | $32.32 | $0.00 – $483.21 | 113,569 | 28 |
| Atascadero, CA | $69.02 | $0.00 – $621.44 | 113,712 | 38 |
| Forestville, MD | $81.39 | $20.00 – $113.87 | 113,924 | 5 |
| Irmo, SC | $69.83 | $6.66 – $83.85 | 114,034 | 48 |
| Hauppauge, NY | $66.66 | $0.60 – $153.46 | 114,194 | 48 |
| Kewanee, IL | $4.33 | $0.00 – $49.58 | 114,312 | 9 |
| Clare, MI | $30.40 | $0.00 – $81.65 | 114,370 | 13 |
| Mansfield, TX | $47.48 | $0.00 – $274.75 | 114,475 | 85 |
| Greenville, AL | $24.68 | $0.00 – $216.46 | 114,559 | 23 |
| Muscle Shoals, AL | $54.76 | $0.00 – $98.31 | 114,670 | 50 |
| Georgetown, OH | $38.31 | $14.21 – $148.16 | 114,731 | 26 |
| South Jordan, UT | $69.89 | $0.10 – $148.51 | 114,742 | 71 |
| Arlington, WA | $64.10 | $3.95 – $108.58 | 114,805 | 79 |
| Port Chester, NY | $95.98 | $2.71 – $128.62 | 114,858 | 26 |
| San Benito, TX | $27.07 | $0.00 – $38.86 | 114,932 | 19 |
| Groton, CT | $38.10 | $0.00 – $106.49 | 114,979 | 65 |
| Poteau, OK | $186.05 | $23.19 – $701.07 | 115,008 | 49 |
| Duluth, GA | $78.30 | $2.29 – $123.41 | 115,061 | 66 |
| Raymondville, TX | $31.77 | $0.00 – $39.40 | 115,106 | 13 |
| Auburn, AL | $36.79 | $0.00 – $95.71 | 115,202 | 67 |
| Clinton, TN | $44.46 | $9.10 – $59.03 | 115,243 | 48 |
| Garden City, MI | $64.71 | $0.00 – $106.72 | 115,280 | 36 |
| Chaparral, NM | $105.93 | $0.42 – $179.44 | 115,394 | 12 |
| Scottsville, KY | $31.11 | $14.63 – $41.50 | 115,427 | 30 |
| Covington, WA | $54.12 | $0.00 – $91.14 | 115,455 | 65 |
| Mount Laurel, NJ | $76.23 | $0.65 – $197.93 | 115,534 | 72 |
| Rensselaer, IN | $42.87 | $0.00 – $59.34 | 115,603 | 20 |
| Port Townsend, WA | $40.83 | $0.00 – $256.69 | 115,608 | 78 |
| Alvin, TX | $51.03 | $0.00 – $81.27 | 115,680 | 35 |
| Bellerose, NY | $65.83 | $0.00 – $241.68 | 115,805 | 29 |
| Ewing, NJ | $41.39 | $0.81 – $108.52 | 115,806 | 32 |
| San Ramon, CA | $31.34 | $0.00 – $178.88 | 115,834 | 65 |
| Washington, PA | $42.05 | $0.00 – $101.43 | 115,863 | 133 |
| Ridgeland, MS | $35.96 | $0.00 – $112.98 | 115,875 | 61 |
| Greenwood Village, CO | $89.36 | $0.00 – $364.77 | 115,942 | 104 |
| Xenia, OH | $59.50 | $0.20 – $128.79 | 115,982 | 51 |
| Plainville, CT | $29.48 | $0.00 – $95.82 | 116,013 | 49 |
| Havre, MT | $7.86 | $0.00 – $168.54 | 116,133 | 20 |
| West Seneca, NY | $61.64 | $9.21 – $166.24 | 116,138 | 113 |
| Wheaton, IL | $64.98 | $0.00 – $228.86 | 116,180 | 122 |
| Coushatta, LA | $8.76 | $0.00 – $39.69 | 116,266 | 20 |
| Montgomery, OH | $55.64 | $20.00 – $139.49 | 116,416 | 86 |
| Boone, NC | $56.58 | $0.44 – $101.63 | 116,526 | 101 |
| Cushing, OK | $81.68 | $0.54 – $519.00 | 116,834 | 25 |
| Gray, KY | $29.12 | $5.79 – $52.76 | 116,855 | 15 |
| Mooresville, IN | $59.86 | $11.86 – $98.72 | 116,906 | 82 |
| Port Jefferson Station, NY | $82.34 | $6.01 – $190.02 | 117,109 | 92 |
| Derry, NH | $50.55 | $0.00 – $101.61 | 117,143 | 77 |
| Johnson City, NY | $64.00 | $8.50 – $730.79 | 117,183 | 131 |
| Texarkana, AR | $29.10 | $0.00 – $63.12 | 117,212 | 51 |
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.