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 |
|---|---|---|---|---|
| Easton, PA | $39.55 | $0.00 – $120.97 | 124,696 | 142 |
| Bridgton, ME | $4.87 | $3.67 – $47.87 | 124,779 | 9 |
| Ahoskie, NC | $70.89 | $3.45 – $229.45 | 124,828 | 35 |
| Mount Sterling, KY | $34.45 | $0.00 – $72.07 | 125,002 | 34 |
| Jupiter, FL | $55.04 | $0.00 – $141.74 | 125,007 | 81 |
| Cumberland, RI | $69.77 | $4.73 – $129.72 | 125,013 | 52 |
| Palm Bay, FL | $49.11 | $0.00 – $283.32 | 125,116 | 86 |
| Maple Grove, MN | $70.06 | $16.29 – $282.11 | 125,202 | 206 |
| Huntington, IN | $60.23 | $31.92 – $79.73 | 125,248 | 47 |
| Sidney, OH | $46.69 | $8.52 – $107.92 | 125,259 | 68 |
| New Lexington, OH | $35.48 | $0.39 – $318.75 | 125,348 | 22 |
| Fort Walton Beach, FL | $52.56 | $0.00 – $380.76 | 125,386 | 105 |
| Fenton, MI | $56.71 | $14.12 – $88.16 | 125,500 | 23 |
| Angleton, TX | $54.67 | $18.69 – $73.99 | 125,571 | 33 |
| Rushville, IN | $65.51 | $17.71 – $97.52 | 125,636 | 38 |
| Connersville, IN | $59.80 | $23.49 – $83.60 | 125,722 | 37 |
| Butler, PA | $51.28 | $0.00 – $178.16 | 125,896 | 110 |
| West Jordan, UT | $63.69 | $0.00 – $624.65 | 125,957 | 113 |
| Roxboro, NC | $55.43 | $0.00 – $91.79 | 126,014 | 44 |
| Perry, FL | $37.56 | $5.06 – $559.22 | 126,023 | 27 |
| West Bend, WI | $35.08 | $8.02 – $128.56 | 126,049 | 110 |
| Richardson, TX | $38.22 | $0.00 – $260.00 | 126,066 | 95 |
| Canal Winchester, OH | $56.01 | $1.31 – $89.09 | 126,071 | 49 |
| Oak Creek, WI | $38.66 | $7.74 – $85.72 | 126,094 | 81 |
| Woodbury, NJ | $57.01 | $0.04 – $143.19 | 126,144 | 76 |
| Santa Clarita, CA | $29.53 | $0.00 – $790.20 | 126,149 | 84 |
| Franklin, IN | $55.01 | $12.10 – $105.11 | 126,162 | 82 |
| Livingston, TN | $36.69 | $1.73 – $57.78 | 126,295 | 30 |
| Oceanside, NY | $82.58 | $0.00 – $183.41 | 126,308 | 80 |
| Lebanon, IN | $56.60 | $7.85 – $85.35 | 126,395 | 98 |
| Los Alamitos, CA | $30.53 | $0.00 – $147.86 | 126,448 | 91 |
| Glenn Dale, MD | $85.88 | $0.00 – $176.96 | 126,530 | 37 |
| Warrensburg, NY | $60.91 | $20.67 – $120.54 | 126,944 | 30 |
| Lebanon, OH | $45.95 | $0.95 – $97.53 | 127,052 | 52 |
| Oakhurst, CA | $11.86 | $0.33 – $171.03 | 127,089 | 16 |
| Herndon, VA | $61.30 | $14.82 – $98.96 | 127,138 | 54 |
| Little River, SC | $67.29 | $1.89 – $248.15 | 127,199 | 92 |
| Kennett, MO | $42.50 | $0.00 – $180.27 | 127,251 | 44 |
| Hollywood, MD | $55.09 | $33.46 – $137.08 | 127,266 | 30 |
| Downers Grove, IL | $54.01 | $0.00 – $345.00 | 127,334 | 133 |
| Rockledge, FL | $48.45 | $0.00 – $255.05 | 127,366 | 89 |
| Monroe, CT | $58.86 | $4.70 – $127.42 | 127,367 | 31 |
| Sabana Grande, PR | $14.75 | $0.00 – $455.13 | 127,382 | 28 |
| Queens Village, NY | $82.31 | $0.59 – $238.44 | 127,480 | 61 |
| Lake Orion, MI | $56.02 | $0.00 – $78.89 | 127,554 | 20 |
| West Hills, CA | $36.44 | $0.00 – $316.80 | 127,590 | 107 |
| Bloomfield Hills, MI | $56.14 | $0.59 – $118.85 | 127,596 | 45 |
| Oak Park, MI | $58.31 | $0.00 – $80.33 | 127,608 | 23 |
| Du Bois, PA | $40.55 | $0.00 – $116.99 | 127,708 | 79 |
| Paris, IL | $7.99 | $0.00 – $92.44 | 127,715 | 26 |
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.