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 |
|---|---|---|---|---|
| Somers Point, NJ | $50.75 | $2.13 – $121.91 | 127,743 | 100 |
| Delray Beach, FL | $44.44 | $0.00 – $205.23 | 127,851 | 111 |
| Rosedale, MD | $101.73 | $0.26 – $229.20 | 127,895 | 52 |
| Manning, SC | $100.17 | $16.55 – $184.78 | 128,034 | 53 |
| Carmel, NY | $94.80 | $0.00 – $177.18 | 128,125 | 68 |
| Glendale, WI | $34.37 | $0.00 – $63.64 | 128,372 | 64 |
| Malden, MA | $48.48 | $0.00 – $222.43 | 128,532 | 97 |
| Aberdeen, WA | $50.99 | $10.43 – $157.14 | 128,532 | 61 |
| Laconia, NH | $38.44 | $0.00 – $255.67 | 128,575 | 74 |
| La Grande, OR | $39.10 | $2.57 – $150.41 | 128,673 | 82 |
| Somerville, TN | $28.88 | $13.58 – $45.48 | 128,689 | 13 |
| Stanford, KY | $33.16 | $15.00 – $64.21 | 128,713 | 33 |
| Corning, CA | $7.55 | $0.00 – $61.32 | 128,716 | 17 |
| Eldorado, IL | $2.72 | $0.00 – $147.95 | 128,717 | 17 |
| Kannapolis, NC | $64.42 | $1.33 – $283.33 | 128,753 | 54 |
| Pleasant View, TN | $40.64 | $3.64 – $65.86 | 128,851 | 25 |
| Jonesboro, LA | $16.35 | $0.00 – $65.50 | 128,895 | 25 |
| Royal Palm Beach, FL | $44.88 | $0.00 – $111.29 | 128,900 | 43 |
| Branson, MO | $71.70 | $7.54 – $149.25 | 128,967 | 112 |
| Longwood, FL | $66.86 | $0.00 – $133.94 | 128,985 | 58 |
| Hiram, GA | $108.37 | $28.39 – $109.98 | 129,184 | 7 |
| Camuy, PR | $5.79 | $0.00 – $58.12 | 129,394 | 31 |
| Newton, IA | $43.53 | $0.00 – $72.17 | 129,482 | 42 |
| Cedar City, UT | $123.64 | $10.65 – $572.83 | 129,578 | 71 |
| Coronado, CA | $41.76 | $0.29 – $106.70 | 129,693 | 27 |
| Cedarhurst, NY | $82.01 | $0.00 – $161.30 | 129,734 | 41 |
| Sterling, VA | $63.93 | $0.62 – $114.86 | 129,747 | 77 |
| Tifton, GA | $92.55 | $10.75 – $117.74 | 129,762 | 26 |
| Glassboro, NJ | $43.72 | $0.00 – $165.60 | 129,914 | 27 |
| Sullivan, IN | $51.04 | $15.43 – $81.59 | 129,916 | 29 |
| Eaton, OH | $42.27 | $33.59 – $125.30 | 129,937 | 26 |
| Philadelphia, MS | $62.21 | $8.83 – $171.18 | 129,942 | 59 |
| Saint Clairsville, OH | $44.29 | $1.72 – $129.36 | 130,021 | 69 |
| Clarksville, IN | $52.13 | $0.81 – $92.06 | 130,146 | 52 |
| Totowa, NJ | $63.21 | $4.10 – $108.00 | 130,167 | 23 |
| Shelton, WA | $62.83 | $0.00 – $122.14 | 130,413 | 81 |
| Lake Mary, FL | $48.41 | $0.00 – $188.51 | 130,552 | 119 |
| Talladega, AL | $20.51 | $0.00 – $230.80 | 130,616 | 37 |
| Tamuning, GU | $73.89 | $0.00 – $140.39 | 130,648 | 93 |
| Methuen, MA | $45.41 | $1.18 – $157.57 | 130,777 | 76 |
| Tukwila, WA | $21.91 | $0.00 – $92.19 | 130,997 | 42 |
| Scarsdale, NY | $89.22 | $0.00 – $181.80 | 131,123 | 66 |
| Bolivar, TN | $31.00 | $3.99 – $62.63 | 131,179 | 36 |
| Beaver, WV | $59.46 | $13.22 – $80.41 | 131,236 | 13 |
| Reston, VA | $62.69 | $0.00 – $158.74 | 131,243 | 128 |
| Newton, NJ | $52.10 | $0.00 – $109.79 | 131,295 | 48 |
| Greenville, TX | $40.91 | $0.00 – $79.00 | 131,299 | 64 |
| Norwich, NY | $109.21 | $11.92 – $142.52 | 131,478 | 44 |
| Greensburg, KY | $30.89 | $18.20 – $45.65 | 131,574 | 24 |
| Upper Marlboro, MD | $96.70 | $0.00 – $239.94 | 131,663 | 111 |
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.