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 |
|---|---|---|---|---|
| Texarkana, TX | $33.13 | $0.00 – $362.55 | 223,288 | 162 |
| Plainfield, NJ | $41.78 | $2.22 – $103.42 | 223,505 | 48 |
| Vidalia, LA | $33.68 | $0.18 – $231.89 | 223,809 | 22 |
| Valencia, CA | $45.81 | $0.00 – $792.31 | 224,186 | 130 |
| Brighton, CO | $91.16 | $0.06 – $197.06 | 224,647 | 113 |
| Westland, MI | $80.58 | $0.33 – $183.34 | 224,816 | 38 |
| Folsom, CA | $32.80 | $0.00 – $271.60 | 224,895 | 127 |
| Clayton, NC | $62.37 | $0.00 – $187.71 | 224,990 | 118 |
| Brea, CA | $32.16 | $0.00 – $961.41 | 225,024 | 63 |
| Jefferson City, TN | $41.14 | $1.86 – $66.20 | 225,040 | 69 |
| Delaware, OH | $53.89 | $0.00 – $318.75 | 225,323 | 109 |
| Wyandotte, MI | $59.80 | $2.94 – $92.02 | 225,570 | 46 |
| Beaverton, OR | $59.51 | $0.00 – $320.77 | 225,740 | 200 |
| Willows, CA | $18.23 | $0.00 – $602.33 | 225,871 | 19 |
| Pittsburg, CA | $49.66 | $0.00 – $1,143 | 226,308 | 55 |
| Fort Pierce, FL | $35.38 | $0.00 – $143.29 | 226,371 | 121 |
| Prairieville, LA | $47.65 | $0.04 – $104.69 | 226,774 | 53 |
| Windsor Mill, MD | $92.36 | $3.25 – $298.35 | 227,118 | 42 |
| Walla Walla, WA | $47.68 | $0.00 – $190.12 | 227,295 | 154 |
| Davenport, FL | $48.91 | $0.00 – $91.57 | 227,625 | 87 |
| Cape Coral, FL | $46.23 | $0.00 – $194.55 | 227,811 | 152 |
| West Allis, WI | $34.91 | $0.00 – $132.36 | 227,990 | 167 |
| Salem, VA | $48.21 | $0.00 – $115.28 | 228,696 | 152 |
| San Jacinto, CA | $62.92 | $0.00 – $451.55 | 228,738 | 37 |
| Tahlequah, OK | $61.91 | $0.00 – $719.00 | 228,867 | 119 |
| Lewes, DE | $59.41 | $0.00 – $162.19 | 228,910 | 125 |
| Colonial Heights, VA | $57.23 | $3.36 – $102.57 | 229,071 | 118 |
| Sonora, CA | $42.41 | $0.00 – $767.23 | 229,250 | 81 |
| Victoria, TX | $35.79 | $0.00 – $295.47 | 230,068 | 119 |
| Berea, KY | $39.09 | $1.20 – $85.23 | 230,186 | 58 |
| Logansport, IN | $62.84 | $1.32 – $147.90 | 230,500 | 63 |
| North Miami Beach, FL | $32.44 | $0.00 – $136.90 | 230,894 | 100 |
| Wethersfield, CT | $48.14 | $0.00 – $112.35 | 231,236 | 86 |
| Raceland, LA | $43.64 | $0.00 – $83.33 | 232,455 | 44 |
| North Chesterfield, VA | $65.49 | $0.00 – $186.65 | 232,565 | 185 |
| Dunn, NC | $54.30 | $0.00 – $76.42 | 232,724 | 61 |
| Yukon, OK | $76.50 | $0.00 – $529.13 | 232,741 | 101 |
| Valley Stream, NY | $75.26 | $0.00 – $206.97 | 232,741 | 130 |
| Manchester, TN | $32.01 | $0.11 – $59.96 | 233,206 | 65 |
| Clinton, NC | $50.69 | $0.00 – $81.69 | 233,255 | 64 |
| Marysville, CA | $15.97 | $0.00 – $559.74 | 233,299 | 67 |
| San Tan Valley, AZ | $63.08 | $1.31 – $97.50 | 233,373 | 79 |
| Kernersville, NC | $63.68 | $15.27 – $136.72 | 233,538 | 137 |
| Rolla, MO | $65.47 | $0.73 – $674.88 | 233,555 | 143 |
| Bourbonnais, IL | $52.24 | $11.48 – $153.07 | 233,724 | 83 |
| Canoga Park, CA | $6.02 | $0.00 – $663.10 | 233,776 | 52 |
| Bloomfield, CT | $41.42 | $0.00 – $95.30 | 233,789 | 129 |
| Jennings, LA | $17.40 | $0.00 – $62.65 | 233,883 | 41 |
| Lexington, NC | $54.63 | $0.00 – $101.29 | 234,434 | 86 |
| Salyersville, KY | $30.27 | $7.66 – $68.99 | 234,537 | 32 |
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.