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 |
|---|---|---|---|---|
| Effingham, IL | $14.39 | $0.00 – $110.09 | 198,246 | 86 |
| Waukegan, IL | $14.55 | $0.00 – $137.51 | 198,352 | 31 |
| Tigard, OR | $78.25 | $0.91 – $275.03 | 198,488 | 164 |
| Templeton, CA | $35.16 | $0.00 – $237.94 | 198,578 | 58 |
| Bell Gardens, CA | $20.95 | $0.00 – $520.45 | 198,710 | 37 |
| Clarkston, MI | $57.88 | $13.47 – $879.83 | 198,910 | 29 |
| Cypress, TX | $45.01 | $0.00 – $138.66 | 199,007 | 122 |
| Rogersville, TN | $44.29 | $1.34 – $99.75 | 199,047 | 51 |
| Greensburg, PA | $49.62 | $0.00 – $83.33 | 199,249 | 138 |
| La Quinta, CA | $51.37 | $0.00 – $1,403 | 199,308 | 51 |
| Breaux Bridge, LA | $43.11 | $0.00 – $75.72 | 199,434 | 23 |
| South Windsor, CT | $45.00 | $1.53 – $125.29 | 200,254 | 103 |
| Fillmore, CA | $9.60 | $0.05 – $761.78 | 200,325 | 22 |
| Sylvania, OH | $45.33 | $0.00 – $112.38 | 200,405 | 170 |
| Berwyn, IL | $41.83 | $0.00 – $188.50 | 200,574 | 108 |
| Crestview Hills, KY | $40.81 | $4.51 – $102.78 | 200,689 | 148 |
| Hoffman Estates, IL | $59.77 | $0.00 – $319.35 | 200,731 | 121 |
| Roseville, MI | $61.86 | $27.04 – $84.65 | 200,917 | 29 |
| Cudahy, CA | $3.40 | $0.00 – $100.22 | 201,084 | 17 |
| Bentonville, AR | $38.79 | $0.00 – $392.23 | 201,120 | 126 |
| Mcminnville, OR | $52.86 | $0.45 – $665.07 | 201,449 | 106 |
| Benton Harbor, MI | $57.07 | $3.96 – $195.14 | 201,484 | 15 |
| Mount Vernon, IL | $34.63 | $0.00 – $122.82 | 201,538 | 107 |
| Isabela, PR | $1.26 | $0.00 – $73.19 | 201,625 | 47 |
| Kingston, NY | $82.77 | $0.00 – $582.38 | 201,696 | 156 |
| Toa Baja, PR | $3.02 | $0.00 – $72.31 | 201,766 | 52 |
| Marion, IA | $24.24 | $11.89 – $50.99 | 201,900 | 39 |
| Centennial, CO | $74.61 | $0.00 – $234.15 | 201,915 | 162 |
| Queensbury, NY | $57.16 | $3.78 – $182.90 | 201,959 | 79 |
| Marana, AZ | $15.95 | $0.02 – $667.35 | 202,048 | 31 |
| Ravenna, OH | $62.86 | $3.52 – $120.25 | 202,126 | 99 |
| Marietta, GA | $60.16 | $0.00 – $640.00 | 202,247 | 141 |
| Harvey, IL | $7.92 | $0.01 – $150.00 | 202,266 | 45 |
| Donaldsonville, LA | $8.21 | $0.00 – $55.81 | 202,431 | 17 |
| Vero Beach, FL | $46.90 | $0.00 – $302.74 | 202,884 | 193 |
| Gahanna, OH | $47.58 | $3.42 – $220.75 | 202,987 | 174 |
| Queen Creek, AZ | $58.31 | $0.19 – $144.89 | 202,993 | 93 |
| Deming, NM | $103.10 | $0.00 – $202.56 | 203,133 | 41 |
| Chehalis, WA | $48.90 | $0.00 – $320.93 | 203,251 | 66 |
| Mayfield, KY | $32.71 | $0.00 – $53.61 | 203,376 | 50 |
| Scottsboro, AL | $33.70 | $0.00 – $244.27 | 203,423 | 65 |
| Hoboken, NJ | $57.11 | $0.00 – $178.15 | 203,693 | 91 |
| Marksville, LA | $5.94 | $0.00 – $178.45 | 204,006 | 36 |
| Elyria, OH | $50.80 | $3.01 – $157.30 | 204,128 | 105 |
| Addison, IL | $45.76 | $0.00 – $90.01 | 204,148 | 44 |
| Ashland, OH | $51.47 | $6.15 – $146.88 | 204,318 | 85 |
| Rio Grande, PR | $1.84 | $0.00 – $60.82 | 204,585 | 30 |
| Hartford, KY | $32.57 | $0.00 – $52.93 | 205,078 | 29 |
| Weirton, WV | $32.53 | $0.00 – $89.16 | 205,641 | 90 |
| Plant City, FL | $40.98 | $0.00 – $144.56 | 205,649 | 66 |
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.