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 |
|---|---|---|---|---|
| Ruston, LA | $25.86 | $0.00 – $67.80 | 478,290 | 107 |
| Frankfort, KY | $38.45 | $1.13 – $92.81 | 479,125 | 128 |
| Warwick, RI | $57.76 | $0.00 – $357.47 | 480,077 | 319 |
| New Hartford, NY | $76.60 | $5.50 – $149.21 | 481,682 | 236 |
| Abingdon, VA | $55.20 | $1.01 – $131.47 | 485,494 | 189 |
| Arlington, VA | $47.67 | $0.00 – $315.80 | 487,162 | 273 |
| Livonia, MI | $65.28 | $0.01 – $103.91 | 487,722 | 109 |
| Simi Valley, CA | $25.22 | $0.00 – $933.89 | 489,366 | 125 |
| Longview, WA | $63.28 | $0.00 – $240.41 | 490,282 | 232 |
| Trenton, NJ | $42.14 | $0.00 – $200.60 | 490,743 | 157 |
| Middletown, OH | $51.46 | $0.48 – $113.78 | 490,917 | 160 |
| Greeley, CO | $90.71 | $0.00 – $676.19 | 491,493 | 336 |
| Huntington Park, CA | $15.53 | $0.00 – $1,224 | 492,480 | 141 |
| Melbourne, FL | $46.75 | $0.00 – $345.38 | 492,716 | 325 |
| Racine, WI | $39.50 | $0.00 – $65.34 | 493,194 | 103 |
| Hampton, VA | $59.16 | $0.00 – $160.24 | 496,065 | 298 |
| Manchester, KY | $31.36 | $0.65 – $65.11 | 497,241 | 67 |
| Ontario, CA | $37.92 | $0.00 – $1,784 | 498,039 | 115 |
| Great Falls, MT | $69.01 | $0.00 – $407.57 | 498,486 | 290 |
| Fairfield, CT | $49.81 | $0.00 – $138.69 | 498,734 | 244 |
| Fresh Meadows, NY | $73.33 | $0.00 – $165.44 | 499,483 | 136 |
| Eureka, CA | $32.25 | $0.00 – $878.88 | 499,776 | 168 |
| Ironton, OH | $43.46 | $0.60 – $145.78 | 500,465 | 65 |
| Holyoke, MA | $62.81 | $0.75 – $165.49 | 500,498 | 171 |
| Bridgeport, WV | $53.99 | $0.00 – $144.19 | 500,743 | 172 |
| Taylor, MI | $60.91 | $0.00 – $92.81 | 501,505 | 60 |
| Columbus, IN | $54.12 | $0.00 – $98.64 | 503,010 | 260 |
| Midland, MI | $56.60 | $0.88 – $247.76 | 503,950 | 57 |
| New Albany, IN | $51.70 | $0.00 – $318.75 | 504,337 | 230 |
| Salisbury, NC | $61.24 | $0.00 – $169.84 | 504,467 | 208 |
| Decatur, IL | $24.65 | $0.00 – $101.24 | 505,157 | 222 |
| Beverly Hills, CA | $49.91 | $0.00 – $623.59 | 505,527 | 300 |
| Richland, WA | $50.92 | $0.00 – $456.19 | 505,762 | 316 |
| Thousand Oaks, CA | $48.23 | $0.00 – $950.10 | 506,214 | 112 |
| Traverse City, MI | $64.72 | $0.78 – $250.00 | 506,245 | 139 |
| Homestead, FL | $52.09 | $0.00 – $309.64 | 507,163 | 126 |
| Irving, TX | $39.93 | $0.00 – $756.00 | 507,595 | 209 |
| Provo, UT | $69.85 | $0.00 – $1,050 | 507,964 | 307 |
| Bradenton, FL | $40.79 | $0.00 – $139.07 | 509,792 | 261 |
| Thornton, CO | $80.71 | $0.00 – $197.82 | 511,979 | 245 |
| Chino, CA | $33.65 | $0.00 – $1,258 | 513,808 | 122 |
| San Luis Obispo, CA | $62.92 | $0.00 – $980.51 | 514,146 | 212 |
| Manchester, CT | $47.29 | $0.00 – $172.33 | 514,950 | 228 |
| Shelby, NC | $53.83 | $0.00 – $130.65 | 515,145 | 215 |
| Hamden, CT | $48.08 | $0.00 – $148.04 | 515,755 | 253 |
| Greeneville, TN | $38.81 | $2.73 – $162.62 | 516,870 | 173 |
| Ypsilanti, MI | $79.99 | $0.00 – $237.31 | 517,514 | 97 |
| Fairfield, CA | $27.55 | $0.00 – $1,089 | 518,052 | 215 |
| Statesville, NC | $53.15 | $0.00 – $288.87 | 518,412 | 259 |
| San Fernando, CA | $9.80 | $0.00 – $1,230 | 518,808 | 79 |
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.