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 |
|---|---|---|---|---|
| Newburgh, IN | $55.59 | $9.32 – $140.27 | 307,598 | 236 |
| Milford, CT | $51.31 | $0.00 – $107.43 | 308,046 | 133 |
| Rio Rancho, NM | $93.84 | $0.00 – $654.51 | 308,110 | 203 |
| North Dartmouth, MA | $42.49 | $1.33 – $101.93 | 308,346 | 141 |
| Aguadilla, PR | $15.14 | $0.00 – $119.65 | 309,311 | 138 |
| Wallingford, CT | $50.24 | $0.00 – $124.50 | 309,519 | 115 |
| Steubenville, OH | $55.22 | $12.29 – $174.66 | 309,604 | 111 |
| Sarasota, FL | $52.60 | $0.00 – $997.65 | 309,721 | 329 |
| Red Bluff, CA | $20.96 | $0.00 – $420.80 | 310,287 | 63 |
| Seaside, CA | $16.29 | $0.00 – $368.26 | 310,331 | 15 |
| Burton, MI | $37.97 | $0.00 – $94.79 | 310,719 | 27 |
| Seymour, IN | $52.10 | $3.09 – $106.10 | 310,780 | 141 |
| Mattoon, IL | $35.68 | $0.00 – $110.11 | 310,990 | 135 |
| Framingham, MA | $61.05 | $0.35 – $157.74 | 311,025 | 193 |
| Ville Platte, LA | $15.76 | $0.00 – $68.34 | 311,036 | 45 |
| Union, NJ | $45.18 | $0.00 – $254.96 | 311,065 | 118 |
| Crown Point, IN | $57.70 | $4.13 – $233.57 | 311,152 | 180 |
| Bolingbrook, IL | $45.57 | $0.00 – $153.82 | 311,228 | 82 |
| Helena, MT | $67.63 | $0.00 – $483.68 | 311,254 | 217 |
| West Orange, NJ | $53.41 | $0.00 – $400.74 | 311,254 | 158 |
| Cranston, RI | $57.68 | $4.72 – $148.69 | 311,393 | 179 |
| Pinehurst, NC | $43.51 | $0.00 – $454.95 | 311,769 | 256 |
| Boca Raton, FL | $44.35 | $0.00 – $504.30 | 311,946 | 259 |
| Greenfield, MA | $55.82 | $0.00 – $166.25 | 312,097 | 135 |
| Peabody, MA | $51.08 | $0.00 – $233.27 | 312,387 | 204 |
| Longmont, CO | $81.40 | $0.00 – $210.66 | 312,768 | 272 |
| Takoma Park, MD | $78.14 | $0.00 – $206.08 | 313,816 | 77 |
| Mount Vernon, NY | $68.09 | $0.00 – $204.96 | 314,016 | 123 |
| Webster, TX | $49.85 | $0.00 – $161.20 | 314,045 | 164 |
| Rochester, MN | $73.40 | $0.00 – $763.08 | 314,133 | 713 |
| San Leandro, CA | $43.77 | $0.00 – $1,291 | 315,104 | 180 |
| Kettering, OH | $48.87 | $0.00 – $177.74 | 316,054 | 248 |
| Evanston, IL | $30.84 | $0.01 – $163.29 | 316,260 | 227 |
| Bullhead City, AZ | $59.98 | $0.00 – $363.87 | 316,269 | 101 |
| Parma, OH | $47.35 | $0.00 – $318.75 | 316,646 | 152 |
| Aiken, SC | $69.54 | $0.57 – $253.19 | 317,075 | 138 |
| Tarzana, CA | $30.55 | $0.00 – $653.79 | 317,173 | 145 |
| Vacaville, CA | $21.23 | $0.00 – $685.28 | 317,722 | 152 |
| Fort Dodge, IA | $18.59 | $0.00 – $283.75 | 319,826 | 104 |
| Moline, IL | $44.99 | $0.00 – $593.46 | 320,322 | 182 |
| Cape Girardeau, MO | $49.51 | $1.27 – $558.24 | 320,729 | 318 |
| East Brunswick, NJ | $60.03 | $0.94 – $214.14 | 320,866 | 124 |
| Johnstown, PA | $48.32 | $0.00 – $190.03 | 320,949 | 181 |
| Shelbyville, TN | $37.69 | $1.74 – $79.57 | 321,501 | 54 |
| Augusta, ME | $39.94 | $1.50 – $190.05 | 321,589 | 250 |
| Lancaster, SC | $69.40 | $4.75 – $216.87 | 322,561 | 85 |
| Easton, MD | $84.78 | $0.91 – $181.92 | 322,709 | 188 |
| Fair Lawn, NJ | $55.98 | $0.00 – $154.69 | 323,172 | 106 |
| Bardstown, KY | $39.53 | $4.85 – $76.74 | 323,569 | 108 |
| Elkhart, IN | $49.36 | $8.49 – $256.77 | 323,807 | 178 |
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.