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 |
|---|---|---|---|---|
| Metuchen, NJ | $74.71 | $0.74 – $122.35 | 184,849 | 29 |
| Edmonds, WA | $43.17 | $0.00 – $126.81 | 184,894 | 172 |
| Bellefontaine, OH | $38.54 | $1.96 – $91.75 | 185,677 | 81 |
| Ferndale, MI | $79.81 | $0.00 – $122.25 | 185,902 | 12 |
| Barboursville, WV | $44.97 | $0.93 – $80.12 | 185,922 | 51 |
| Dover, NH | $38.37 | $0.00 – $100.34 | 186,155 | 185 |
| Des Plaines, IL | $32.86 | $0.00 – $213.83 | 186,241 | 106 |
| Centralia, IL | $35.00 | $0.01 – $106.22 | 186,551 | 43 |
| Elkin, NC | $40.50 | $0.00 – $91.67 | 186,593 | 77 |
| Southbridge, MA | $54.94 | $6.08 – $109.48 | 186,614 | 80 |
| Cidra, PR | $4.73 | $0.00 – $59.00 | 186,679 | 54 |
| Pittsburg, KS | $111.77 | $0.00 – $236.62 | 186,987 | 98 |
| Vega Baja, PR | $5.95 | $0.00 – $91.22 | 186,988 | 58 |
| Canton, MS | $50.44 | $0.00 – $229.77 | 187,203 | 56 |
| Ansonia, CT | $65.82 | $0.00 – $118.79 | 187,217 | 49 |
| Rio Piedras, PR | $26.03 | $0.00 – $87.47 | 187,350 | 75 |
| South Plainfield, NJ | $45.92 | $0.84 – $108.92 | 187,380 | 47 |
| Huntington, NY | $99.86 | $1.31 – $251.56 | 187,419 | 127 |
| Kosciusko, MS | $60.49 | $4.71 – $137.66 | 187,441 | 31 |
| Caldwell, ID | $44.71 | $0.00 – $594.96 | 187,554 | 125 |
| Independence, MO | $63.35 | $0.00 – $163.66 | 187,560 | 138 |
| Ronceverte, WV | $52.27 | $0.00 – $81.79 | 187,690 | 47 |
| Fond Du Lac, WI | $30.99 | $0.00 – $148.99 | 187,764 | 163 |
| Marshall, MI | $57.27 | $20.39 – $130.45 | 188,032 | 23 |
| North Miami, FL | $25.53 | $0.00 – $308.32 | 188,122 | 83 |
| Big Rapids, MI | $40.19 | $0.14 – $91.72 | 188,228 | 19 |
| Prescott Valley, AZ | $57.23 | $0.00 – $271.19 | 188,286 | 98 |
| Blacksburg, VA | $59.61 | $1.82 – $318.75 | 188,307 | 109 |
| Melrose Park, IL | $42.53 | $0.00 – $94.29 | 188,323 | 54 |
| East Chicago, IN | $56.15 | $0.00 – $85.08 | 188,524 | 59 |
| Greenfield, IN | $52.36 | $0.00 – $95.95 | 188,566 | 103 |
| Patterson, CA | $15.21 | $0.00 – $116.50 | 188,789 | 20 |
| Tiffin, OH | $40.64 | $1.36 – $64.67 | 188,827 | 59 |
| Othello, WA | $20.66 | $0.00 – $61.61 | 189,160 | 38 |
| Lexington, TN | $41.42 | $9.91 – $78.58 | 189,189 | 48 |
| Flemington, NJ | $81.77 | $6.79 – $160.50 | 189,240 | 172 |
| Irvington, NJ | $39.84 | $1.45 – $161.06 | 189,332 | 41 |
| Hopewell, VA | $51.48 | $11.31 – $105.66 | 189,412 | 40 |
| Milford, OH | $58.63 | $9.36 – $139.72 | 189,536 | 92 |
| Sunnyvale, CA | $6.52 | $0.00 – $221.59 | 189,596 | 73 |
| Senatobia, MS | $49.13 | $0.00 – $75.38 | 189,613 | 42 |
| Hillsboro, OH | $33.39 | $0.00 – $155.97 | 189,834 | 49 |
| Paris, TN | $31.76 | $0.26 – $73.85 | 190,291 | 64 |
| Prince Frederick, MD | $80.02 | $0.00 – $136.33 | 190,389 | 102 |
| Picayune, MS | $61.01 | $5.79 – $142.96 | 190,620 | 68 |
| Espanola, NM | $107.80 | $1.84 – $463.47 | 190,628 | 55 |
| Fremont, OH | $43.79 | $0.00 – $106.05 | 190,742 | 76 |
| Madison, IN | $49.14 | $0.00 – $307.76 | 190,923 | 72 |
| Mcminnville, TN | $38.33 | $2.36 – $176.99 | 191,139 | 62 |
| Bridgeton, NJ | $23.96 | $0.00 – $108.82 | 191,189 | 52 |
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.