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 |
|---|---|---|---|---|
| Danville, PA | $52.78 | $0.00 – $145.85 | 342,242 | 393 |
| Glens Falls, NY | $80.63 | $0.00 – $161.49 | 342,629 | 174 |
| Seaford, DE | $38.92 | $0.00 – $310.64 | 342,965 | 78 |
| Lebanon, TN | $38.42 | $0.00 – $96.06 | 343,010 | 132 |
| Franklin, TN | $44.55 | $0.00 – $241.94 | 343,086 | 216 |
| Trumbull, CT | $50.09 | $0.00 – $153.65 | 343,162 | 212 |
| South Gate, CA | $11.72 | $0.00 – $101.21 | 343,795 | 89 |
| Naples, FL | $46.13 | $0.00 – $200.00 | 344,059 | 284 |
| Alliance, OH | $46.34 | $1.55 – $101.04 | 344,180 | 123 |
| Harlan, KY | $35.92 | $14.94 – $91.28 | 344,818 | 51 |
| Abilene, TX | $40.98 | $1.61 – $223.18 | 345,281 | 224 |
| Wheelersburg, OH | $37.77 | $0.24 – $137.01 | 345,720 | 41 |
| Morgan City, LA | $36.82 | $0.00 – $71.76 | 346,791 | 52 |
| Great Neck, NY | $81.64 | $0.00 – $218.92 | 346,854 | 250 |
| Fort Lauderdale, FL | $46.71 | $0.00 – $176.20 | 347,890 | 251 |
| San Juan Capistrano, CA | $22.53 | $0.00 – $100.91 | 348,117 | 31 |
| Hollister, CA | $20.06 | $0.00 – $794.36 | 349,154 | 56 |
| Wasilla, AK | $132.79 | $0.00 – $825.26 | 350,051 | 203 |
| West Chester, OH | $53.49 | $2.56 – $316.08 | 350,490 | 226 |
| Arcata, CA | $17.08 | $0.00 – $140.48 | 350,803 | 71 |
| Athens, TN | $40.12 | $1.29 – $80.94 | 350,808 | 67 |
| Morristown, NJ | $63.04 | $0.00 – $447.26 | 350,956 | 298 |
| Hesperia, CA | $24.08 | $0.00 – $182.44 | 351,394 | 67 |
| Cambridge, OH | $32.40 | $2.41 – $101.79 | 351,500 | 89 |
| Plattsburgh, NY | $81.03 | $0.00 – $234.62 | 352,712 | 147 |
| North Charleston, SC | $66.87 | $0.00 – $345.00 | 352,747 | 184 |
| Owosso, MI | $51.04 | $0.00 – $200.52 | 353,534 | 23 |
| Towson, MD | $74.63 | $0.00 – $560.42 | 354,092 | 260 |
| Pocatello, ID | $53.27 | $0.00 – $290.25 | 354,345 | 235 |
| Augusta, GA | $68.85 | $0.00 – $579.48 | 354,572 | 325 |
| Burlington, MA | $95.84 | $0.00 – $181.92 | 354,634 | 370 |
| Rialto, CA | $32.83 | $0.00 – $937.70 | 354,682 | 68 |
| Fayetteville, AR | $41.09 | $0.00 – $126.47 | 355,072 | 248 |
| Clermont, FL | $49.85 | $0.00 – $230.00 | 355,191 | 145 |
| Morganton, NC | $50.60 | $0.00 – $158.22 | 355,198 | 159 |
| Poplar Bluff, MO | $49.21 | $0.00 – $153.27 | 355,974 | 151 |
| Coral Gables, FL | $34.53 | $0.00 – $315.07 | 357,757 | 179 |
| Bastrop, LA | $24.96 | $0.00 – $95.67 | 358,049 | 47 |
| Marion, IL | $12.55 | $0.00 – $93.78 | 358,121 | 89 |
| Lake Elsinore, CA | $9.75 | $0.00 – $1,875 | 359,381 | 44 |
| Corona, NY | $29.10 | $0.00 – $168.93 | 359,848 | 79 |
| Sanford, FL | $87.40 | $0.00 – $139.65 | 360,160 | 74 |
| Bloomington, IL | $42.85 | $0.00 – $126.16 | 361,601 | 200 |
| Novi, MI | $75.46 | $0.00 – $111.10 | 361,908 | 60 |
| Pico Rivera, CA | $12.45 | $0.00 – $797.20 | 362,301 | 55 |
| Hilo, HI | $62.82 | $0.00 – $251.66 | 362,488 | 171 |
| Elkton, MD | $71.73 | $0.00 – $167.57 | 363,054 | 107 |
| Belleville, NJ | $45.90 | $0.00 – $101.66 | 363,397 | 86 |
| Altamonte Springs, FL | $61.20 | $0.00 – $192.58 | 363,894 | 137 |
| Aibonito, PR | $14.33 | $0.00 – $81.67 | 364,066 | 74 |
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.