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 |
|---|---|---|---|---|
| Newport, KY | $39.64 | $5.92 – $110.80 | 157,863 | 65 |
| Shelton, CT | $57.60 | $0.00 – $138.97 | 157,907 | 110 |
| Hazel Park, MI | $69.39 | $0.00 – $81.38 | 157,952 | 12 |
| Gaylord, MI | $33.00 | $4.36 – $77.71 | 158,118 | 15 |
| Rancho Cordova, CA | $10.19 | $0.00 – $157.41 | 158,220 | 61 |
| Toppenish, WA | $24.67 | $0.00 – $257.53 | 158,228 | 53 |
| Donna, TX | $33.91 | $1.99 – $72.39 | 158,307 | 24 |
| Pikesville, MD | $89.07 | $0.00 – $205.77 | 158,446 | 81 |
| Mount Morris, MI | $67.06 | $41.73 – $82.32 | 158,493 | 4 |
| West Lafayette, IN | $61.64 | $24.44 – $144.10 | 158,613 | 86 |
| Lamont, CA | $38.73 | $3.72 – $596.91 | 158,672 | 25 |
| Canfield, OH | $54.68 | $14.71 – $102.50 | 158,817 | 51 |
| Moore, OK | $95.87 | $0.00 – $648.21 | 158,850 | 98 |
| Coconut Creek, FL | $50.80 | $0.00 – $196.37 | 158,907 | 61 |
| Libertyville, IL | $43.30 | $0.00 – $127.96 | 158,925 | 107 |
| Marysville, MI | $48.80 | $3.10 – $59.38 | 159,033 | 4 |
| Duncan, OK | $141.76 | $18.69 – $574.26 | 159,155 | 70 |
| Manalapan, NJ | $54.26 | $0.00 – $201.03 | 159,315 | 59 |
| Middletown, DE | $45.05 | $0.00 – $102.48 | 159,466 | 40 |
| Lyndhurst, NJ | $63.27 | $15.67 – $91.98 | 159,755 | 21 |
| Linwood, NJ | $45.65 | $0.00 – $71.72 | 159,811 | 41 |
| Cheektowaga, NY | $58.61 | $0.00 – $220.56 | 159,935 | 107 |
| Boaz, AL | $41.14 | $0.00 – $84.90 | 160,216 | 44 |
| Staunton, VA | $55.86 | $0.00 – $88.18 | 160,228 | 59 |
| Franklin, LA | $23.29 | $0.00 – $56.94 | 160,361 | 32 |
| Chelmsford, MA | $58.53 | $0.00 – $264.18 | 160,545 | 119 |
| Carrollton, GA | $60.90 | $4.97 – $105.50 | 160,666 | 90 |
| Sault Sainte Marie, MI | $53.11 | $1.97 – $355.06 | 160,882 | 25 |
| Gardner, MA | $62.74 | $0.00 – $153.73 | 160,889 | 72 |
| Clinton, IA | $32.87 | $0.08 – $67.89 | 161,041 | 79 |
| Winter Garden, FL | $45.16 | $0.00 – $135.07 | 161,246 | 95 |
| Clinton, LA | $6.46 | $0.00 – $60.49 | 161,431 | 36 |
| Deridder, LA | $21.45 | $0.00 – $78.93 | 161,666 | 44 |
| Petoskey, MI | $83.46 | $0.07 – $816.36 | 161,700 | 54 |
| Harvey, LA | $31.97 | $0.00 – $85.79 | 161,754 | 45 |
| Dayton, TN | $37.30 | $0.23 – $545.37 | 161,778 | 40 |
| Bozeman, MT | $87.35 | $0.00 – $373.12 | 161,915 | 271 |
| Los Gatos, CA | $21.01 | $0.00 – $1,139 | 162,082 | 95 |
| Farmville, VA | $55.96 | $7.99 – $128.47 | 162,770 | 63 |
| Forest City, NC | $44.95 | $0.00 – $94.95 | 162,907 | 57 |
| Litchfield Park, AZ | $61.51 | $12.46 – $113.67 | 162,947 | 69 |
| Dillon, SC | $64.28 | $23.67 – $357.53 | 162,987 | 38 |
| Ankeny, IA | $37.13 | $0.00 – $87.04 | 163,217 | 136 |
| Williamson, WV | $24.67 | $0.00 – $81.38 | 163,323 | 35 |
| Morovis, PR | $4.69 | $0.00 – $47.83 | 163,658 | 27 |
| Oneida, NY | $77.82 | $10.55 – $621.89 | 163,749 | 80 |
| East Setauket, NY | $87.84 | $0.00 – $214.47 | 163,824 | 180 |
| Lakeport, CA | $17.40 | $0.00 – $254.44 | 164,019 | 45 |
| Fallbrook, CA | $20.63 | $0.00 – $120.94 | 164,088 | 24 |
| Millville, NJ | $33.12 | $0.00 – $83.15 | 164,095 | 34 |
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.