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 |
|---|---|---|---|---|
| Placerville, CA | $44.24 | $0.00 – $410.61 | 243,674 | 93 |
| Westlake, OH | $42.38 | $0.63 – $119.69 | 243,754 | 244 |
| Boulder, CO | $96.83 | $0.00 – $679.96 | 244,107 | 277 |
| Palm Desert, CA | $53.76 | $0.00 – $397.00 | 244,605 | 85 |
| Sanford, NC | $56.54 | $0.12 – $188.30 | 244,625 | 165 |
| Lincolnton, NC | $55.97 | $9.23 – $88.10 | 244,731 | 95 |
| Broken Arrow, OK | $82.06 | $0.00 – $400.08 | 244,745 | 114 |
| Granite City, IL | $23.16 | $0.00 – $166.66 | 244,898 | 48 |
| Freeport, NY | $49.51 | $0.00 – $236.72 | 245,410 | 66 |
| Bowie, MD | $77.40 | $0.47 – $226.08 | 245,498 | 155 |
| Clarksdale, MS | $59.91 | $0.00 – $171.52 | 245,509 | 71 |
| Arcadia, CA | $37.54 | $0.00 – $810.61 | 246,763 | 189 |
| Elizabeth City, NC | $44.41 | $0.00 – $128.98 | 247,048 | 128 |
| Stafford, VA | $64.33 | $0.00 – $103.65 | 247,379 | 73 |
| West Burlington, IA | $23.20 | $0.00 – $63.22 | 247,532 | 105 |
| Winslow, AZ | $498.15 | $0.00 – $548.68 | 248,023 | 36 |
| Henderson, NC | $50.11 | $0.00 – $97.17 | 248,397 | 78 |
| Bethel, AK | $198.41 | $0.00 – $779.26 | 248,650 | 102 |
| Waverly, OH | $38.68 | $0.28 – $122.14 | 248,728 | 42 |
| Mt Pleasant, MI | $125.04 | $0.00 – $297.64 | 248,964 | 36 |
| Wilmington, OH | $43.62 | $0.40 – $112.28 | 249,036 | 86 |
| Bloomfield, NJ | $42.46 | $0.00 – $223.07 | 249,044 | 76 |
| Brentwood, NY | $59.90 | $12.08 – $162.40 | 249,153 | 48 |
| New Albany, MS | $49.16 | $7.45 – $135.23 | 249,675 | 96 |
| Carlsbad, NM | $83.99 | $27.10 – $194.42 | 249,698 | 82 |
| Commack, NY | $85.61 | $0.00 – $172.01 | 249,730 | 81 |
| Portage, MI | $67.27 | $6.79 – $286.85 | 249,805 | 33 |
| San Mateo, CA | $50.22 | $0.00 – $1,537 | 249,879 | 177 |
| Apopka, FL | $47.84 | $0.63 – $738.94 | 249,920 | 96 |
| Winter Haven, FL | $54.07 | $0.00 – $116.79 | 250,254 | 167 |
| Hermitage, TN | $39.12 | $5.73 – $829.31 | 250,984 | 135 |
| Austintown, OH | $63.14 | $2.07 – $141.36 | 251,153 | 64 |
| Putnam, CT | $44.74 | $0.00 – $109.09 | 251,187 | 83 |
| Hyannis, MA | $53.14 | $0.00 – $177.68 | 251,266 | 226 |
| Wooster, OH | $52.06 | $0.00 – $120.54 | 251,324 | 167 |
| Palm Springs, FL | $60.06 | $0.00 – $318.75 | 251,679 | 54 |
| Oshkosh, WI | $34.26 | $0.69 – $271.75 | 251,844 | 226 |
| Mason City, IA | $32.52 | $0.00 – $313.15 | 251,985 | 192 |
| Duluth, MN | $68.97 | $0.00 – $621.30 | 252,568 | 482 |
| Ridgewood, NY | $36.48 | $0.00 – $121.19 | 252,574 | 44 |
| Garden City, NY | $79.19 | $0.00 – $303.71 | 252,781 | 185 |
| Laurinburg, NC | $51.61 | $3.67 – $87.06 | 253,672 | 86 |
| Mountain Home, AR | $37.35 | $0.45 – $169.97 | 253,925 | 128 |
| Wichita Falls, TX | $47.34 | $0.00 – $736.72 | 254,096 | 201 |
| Pearland, TX | $51.45 | $0.00 – $421.88 | 254,247 | 142 |
| Patchogue, NY | $68.01 | $0.00 – $169.41 | 254,368 | 100 |
| Teaneck, NJ | $50.18 | $1.92 – $166.08 | 254,672 | 140 |
| Lenoir, NC | $45.19 | $5.56 – $121.69 | 254,696 | 112 |
| Pahrump, NV | $45.24 | $0.00 – $173.56 | 254,767 | 75 |
| Freehold, NJ | $62.87 | $0.00 – $198.68 | 254,912 | 146 |
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.