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 |
|---|---|---|---|---|
| Babylon, NY | $71.14 | $20.14 – $168.60 | 191,194 | 75 |
| Auburn Hills, MI | $103.68 | $0.00 – $114.95 | 191,413 | 12 |
| Bethesda, MD | $67.01 | $0.00 – $597.72 | 192,123 | 225 |
| San Sebastian, PR | $2.43 | $0.00 – $54.82 | 192,157 | 53 |
| Grayson, KY | $34.25 | $13.29 – $60.21 | 192,319 | 40 |
| Frenchburg, KY | $32.38 | $0.05 – $52.19 | 192,522 | 22 |
| Georgetown, SC | $74.04 | $7.44 – $199.74 | 192,650 | 70 |
| Batesville, AR | $36.52 | $0.00 – $660.57 | 193,223 | 126 |
| Riverview, FL | $46.83 | $0.26 – $137.51 | 193,284 | 93 |
| New Port Richey, FL | $56.73 | $0.00 – $520.77 | 193,356 | 122 |
| Beaufort, SC | $80.54 | $0.00 – $201.53 | 193,427 | 106 |
| Barberton, OH | $52.80 | $0.01 – $158.40 | 193,500 | 74 |
| Brookline, MA | $55.59 | $3.25 – $109.00 | 193,555 | 129 |
| Troy, OH | $52.31 | $0.35 – $324.39 | 193,597 | 121 |
| Marshalltown, IA | $27.72 | $0.00 – $177.20 | 193,666 | 77 |
| Bessemer, AL | $55.08 | $0.00 – $173.46 | 193,696 | 60 |
| Many, LA | $13.38 | $0.00 – $69.20 | 193,749 | 23 |
| Chalmette, LA | $31.31 | $0.00 – $76.14 | 193,907 | 49 |
| South Boston, VA | $57.41 | $2.58 – $86.24 | 194,176 | 81 |
| Rexburg, ID | $51.15 | $0.00 – $195.87 | 194,221 | 91 |
| Buckhannon, WV | $24.96 | $0.00 – $112.10 | 194,372 | 78 |
| North Andover, MA | $46.30 | $0.00 – $139.55 | 194,498 | 93 |
| West Islip, NY | $89.95 | $0.00 – $175.53 | 195,100 | 129 |
| Jackson, OH | $39.95 | $0.00 – $121.76 | 195,252 | 52 |
| Marion, VA | $56.01 | $4.61 – $112.43 | 195,259 | 57 |
| Irvine, KY | $31.56 | $0.00 – $91.69 | 195,280 | 37 |
| Newington, CT | $61.84 | $0.00 – $96.11 | 195,452 | 63 |
| Sylacauga, AL | $34.14 | $0.00 – $228.72 | 195,542 | 49 |
| East Syracuse, NY | $77.03 | $0.00 – $151.38 | 195,555 | 171 |
| Wheeling, IL | $44.24 | $0.00 – $72.79 | 195,586 | 19 |
| Waipahu, HI | $64.92 | $0.00 – $284.80 | 195,696 | 97 |
| Aberdeen, MD | $70.61 | $0.00 – $148.93 | 195,876 | 41 |
| Pickerington, OH | $47.30 | $13.80 – $328.12 | 196,014 | 95 |
| Sheboygan, WI | $31.92 | $0.14 – $228.45 | 196,151 | 231 |
| Jacksonville, IL | $15.53 | $0.00 – $94.27 | 196,221 | 63 |
| Hillsdale, MI | $39.88 | $2.19 – $70.45 | 196,229 | 24 |
| North Canton, OH | $47.12 | $12.22 – $122.01 | 196,275 | 100 |
| Fowler, CA | $2.27 | $0.00 – $57.93 | 196,449 | 18 |
| New Windsor, NY | $76.84 | $12.08 – $133.55 | 196,477 | 76 |
| Larkspur, CA | $5.10 | $0.00 – $107.64 | 196,734 | 52 |
| West Memphis, AR | $42.16 | $0.00 – $68.27 | 196,737 | 51 |
| Brookhaven, MS | $47.08 | $0.00 – $101.28 | 196,780 | 98 |
| Fitchburg, MA | $46.06 | $0.00 – $102.75 | 197,018 | 74 |
| Miami Beach, FL | $29.27 | $0.00 – $231.88 | 197,250 | 179 |
| Waterville, ME | $38.79 | $0.00 – $84.37 | 197,323 | 150 |
| Saint Cloud, MN | $68.26 | $0.00 – $679.74 | 197,504 | 231 |
| Elmhurst, IL | $53.87 | $0.00 – $119.44 | 197,533 | 204 |
| Phila, PA | $37.18 | $0.00 – $90.20 | 197,942 | 87 |
| Albertville, AL | $36.50 | $0.00 – $106.50 | 198,179 | 58 |
| Keene, NH | $42.60 | $0.00 – $568.29 | 198,240 | 200 |
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.