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 |
|---|---|---|---|---|
| Gadsden, AL | $56.92 | $0.00 – $746.48 | 364,159 | 185 |
| Monterey, CA | $64.35 | $0.00 – $179.63 | 364,712 | 201 |
| Rayville, LA | $14.52 | $0.00 – $42.35 | 364,806 | 32 |
| Middle Village, NY | $85.73 | $0.00 – $205.89 | 365,419 | 32 |
| Mission Viejo, CA | $48.74 | $0.00 – $573.49 | 366,207 | 142 |
| Coeur D Alene, ID | $58.73 | $0.00 – $185.33 | 366,360 | 296 |
| Wilson, NC | $51.18 | $0.00 – $107.01 | 366,389 | 141 |
| Corvallis, OR | $66.85 | $0.00 – $564.40 | 366,919 | 335 |
| Hendersonville, TN | $32.29 | $0.00 – $450.94 | 367,290 | 158 |
| Secaucus, NJ | $61.45 | $0.00 – $161.45 | 368,244 | 73 |
| Daly City, CA | $23.26 | $0.00 – $1,693 | 368,830 | 182 |
| South Richmond Hill, NY | $63.92 | $0.00 – $138.37 | 369,123 | 52 |
| Monticello, KY | $30.61 | $8.26 – $59.10 | 369,394 | 56 |
| Shiprock, NM | $429.35 | $0.00 – $649.11 | 369,750 | 110 |
| Yauco, PR | $3.48 | $0.00 – $148.20 | 369,812 | 54 |
| Longview, TX | $44.10 | $0.00 – $213.25 | 370,295 | 231 |
| Pineville, LA | $37.41 | $0.00 – $95.70 | 371,237 | 78 |
| Lake Worth, FL | $63.33 | $0.00 – $136.01 | 371,591 | 70 |
| Opelika, AL | $61.25 | $0.00 – $304.48 | 372,287 | 144 |
| Culver City, CA | $26.49 | $0.00 – $789.41 | 373,443 | 107 |
| Santa Monica, CA | $22.57 | $0.00 – $652.21 | 373,557 | 291 |
| Dubuque, IA | $32.20 | $0.00 – $318.75 | 373,672 | 254 |
| Arlington Heights, IL | $18.57 | $0.01 – $154.46 | 374,187 | 147 |
| Nampa, ID | $42.89 | $0.00 – $172.08 | 374,219 | 302 |
| Carmel, IN | $63.62 | $0.05 – $138.12 | 374,748 | 393 |
| East Meadow, NY | $75.78 | $0.00 – $204.17 | 375,074 | 162 |
| Henderson, KY | $38.07 | $6.91 – $73.73 | 375,636 | 113 |
| Fullerton, CA | $41.06 | $0.00 – $570.41 | 375,817 | 202 |
| Port Angeles, WA | $86.32 | $1.17 – $159.03 | 376,750 | 152 |
| Beachwood, OH | $51.17 | $0.17 – $318.75 | 376,825 | 295 |
| Venice, CA | $2.84 | $0.00 – $924.91 | 377,275 | 59 |
| Crowley, LA | $32.23 | $0.00 – $91.32 | 377,412 | 55 |
| Garland, TX | $39.30 | $0.00 – $700.27 | 377,417 | 142 |
| Troy, NY | $70.25 | $7.48 – $142.80 | 377,568 | 195 |
| West Hartford, CT | $45.66 | $0.00 – $116.56 | 378,248 | 213 |
| Williamsburg, VA | $67.00 | $15.24 – $142.47 | 378,404 | 198 |
| Lakewood, WA | $51.54 | $0.00 – $178.25 | 378,652 | 159 |
| Orangeburg, SC | $70.38 | $0.00 – $248.56 | 378,915 | 158 |
| Harrisburg, PA | $39.02 | $0.00 – $251.30 | 379,411 | 297 |
| Lynwood, CA | $22.51 | $0.00 – $918.36 | 379,618 | 119 |
| Amsterdam, NY | $78.01 | $0.00 – $133.18 | 381,405 | 106 |
| Mount Vernon, OH | $50.32 | $0.00 – $135.44 | 381,559 | 118 |
| Goshen, IN | $69.06 | $0.00 – $149.02 | 382,179 | 194 |
| Atwater, CA | $27.94 | $0.00 – $84.30 | 386,111 | 26 |
| San Rafael, CA | $11.51 | $0.00 – $875.55 | 386,259 | 120 |
| Kingman, AZ | $45.06 | $0.00 – $120.19 | 386,556 | 153 |
| Georgetown, KY | $38.80 | $5.22 – $112.83 | 387,461 | 115 |
| Pleasanton, CA | $33.17 | $0.00 – $1,017 | 388,049 | 146 |
| Gallatin, TN | $40.54 | $0.80 – $77.92 | 388,382 | 142 |
| Pawtucket, RI | $58.11 | $0.00 – $132.55 | 389,301 | 200 |
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.