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 |
|---|---|---|---|---|
| Santa Clara, CA | $17.48 | $0.00 – $235.83 | 205,653 | 170 |
| Montclair, CA | $34.07 | $0.00 – $111.73 | 206,042 | 63 |
| Middlebury, CT | $42.41 | $0.00 – $133.89 | 206,374 | 68 |
| Auburn, CA | $23.45 | $0.00 – $977.36 | 206,429 | 88 |
| San Joaquin, CA | $19.36 | $9.41 – $59.09 | 206,498 | 4 |
| Eden, NC | $52.79 | $10.07 – $79.06 | 206,682 | 52 |
| Lake Wales, FL | $47.79 | $0.00 – $82.60 | 206,702 | 31 |
| Aguada, PR | $9.05 | $0.00 – $79.24 | 206,865 | 65 |
| Richmond, CA | $14.95 | $0.00 – $165.52 | 206,935 | 109 |
| Piscataway, NJ | $50.93 | $0.00 – $137.84 | 207,077 | 43 |
| Sayre, PA | $69.39 | $0.00 – $163.77 | 207,114 | 133 |
| Plaquemine, LA | $32.74 | $0.00 – $75.17 | 207,178 | 24 |
| Burlingame, CA | $23.57 | $0.00 – $225.59 | 207,357 | 104 |
| Orange, CT | $58.57 | $0.00 – $123.48 | 207,437 | 60 |
| Salem, MA | $52.29 | $0.00 – $633.79 | 207,503 | 171 |
| Williamsburg, KY | $30.68 | $10.85 – $114.66 | 207,511 | 44 |
| Madison Heights, MI | $52.53 | $14.82 – $98.80 | 207,550 | 24 |
| Somerton, AZ | $1.52 | $0.00 – $77.53 | 207,597 | 13 |
| Clackamas, OR | $83.22 | $0.00 – $305.20 | 207,867 | 243 |
| San Pablo, CA | $39.02 | $0.00 – $1,154 | 208,003 | 66 |
| New Rochelle, NY | $78.58 | $0.00 – $223.55 | 208,017 | 133 |
| Selden, NY | $127.87 | $9.58 – $144.33 | 208,078 | 10 |
| Zephyrhills, FL | $46.03 | $0.00 – $295.39 | 208,700 | 109 |
| Albany, KY | $24.57 | $11.23 – $38.38 | 208,913 | 18 |
| El Dorado, AR | $40.41 | $4.05 – $84.56 | 208,917 | 62 |
| Whitley City, KY | $28.36 | $10.29 – $144.98 | 209,085 | 26 |
| Reading, PA | $40.48 | $0.00 – $290.73 | 209,225 | 143 |
| Oneida, TN | $35.65 | $12.70 – $64.42 | 209,327 | 34 |
| San Angelo, TX | $47.74 | $0.00 – $106.39 | 209,399 | 210 |
| Shawnee, OK | $142.36 | $0.00 – $719.00 | 209,505 | 116 |
| Woodside, NY | $63.59 | $0.00 – $179.63 | 209,587 | 57 |
| Harrisville, MI | $18.03 | $2.37 – $18.15 | 209,735 | 3 |
| Dorchester Center, MA | $106.63 | $0.86 – $271.31 | 209,779 | 32 |
| Atlantic City, NJ | $37.74 | $0.01 – $127.26 | 209,868 | 79 |
| Farmington, MO | $52.89 | $0.00 – $178.12 | 209,915 | 117 |
| Saratoga Springs, NY | $82.86 | $3.32 – $521.37 | 209,991 | 214 |
| Olean, NY | $65.33 | $0.00 – $185.33 | 210,345 | 123 |
| Sherman, TX | $55.89 | $0.00 – $612.35 | 211,049 | 99 |
| Antioch, CA | $42.14 | $0.00 – $1,061 | 211,057 | 165 |
| Woodland Hills, CA | $30.01 | $0.00 – $1,060 | 211,413 | 226 |
| West Plains, MO | $53.49 | $1.08 – $640.00 | 211,745 | 112 |
| Southington, CT | $45.43 | $0.00 – $102.13 | 211,805 | 90 |
| Pine Bluff, AR | $37.68 | $0.00 – $98.13 | 212,021 | 129 |
| Chicopee, MA | $46.01 | $1.88 – $73.09 | 212,265 | 72 |
| Gridley, CA | $19.01 | $0.00 – $854.62 | 212,321 | 14 |
| Douglas, AZ | $13.49 | $0.00 – $555.26 | 212,339 | 28 |
| Okemos, MI | $49.04 | $0.00 – $99.85 | 212,377 | 42 |
| Cuyahoga Falls, OH | $42.38 | $2.65 – $331.42 | 212,462 | 131 |
| Valhalla, NY | $112.66 | $0.00 – $293.44 | 212,962 | 143 |
| Logan, OH | $45.37 | $0.22 – $125.86 | 213,085 | 56 |
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.