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 |
|---|---|---|---|---|
| Cumberland, MD | $79.07 | $0.00 – $184.15 | 519,245 | 234 |
| Dorchester, MA | $70.45 | $0.00 – $140.89 | 519,593 | 150 |
| Clovis, CA | $8.65 | $0.00 – $143.75 | 520,066 | 158 |
| Whitesburg, KY | $37.12 | $4.28 – $87.16 | 521,312 | 66 |
| Hawthorne, CA | $11.37 | $0.00 – $90.00 | 521,954 | 107 |
| Mount Vernon, WA | $54.16 | $7.63 – $211.02 | 521,967 | 288 |
| Wenatchee, WA | $46.40 | $0.64 – $270.24 | 523,051 | 399 |
| Rapid City, SD | $121.01 | $0.00 – $654.70 | 523,138 | 90 |
| Martinsburg, WV | $40.48 | $0.00 – $229.68 | 523,147 | 197 |
| Petaluma, CA | $6.85 | $0.00 – $660.49 | 524,176 | 133 |
| Falls Church, VA | $61.53 | $0.00 – $255.71 | 524,218 | 382 |
| Mandeville, LA | $42.76 | $0.00 – $130.99 | 524,411 | 113 |
| Berkeley, CA | $20.12 | $0.00 – $506.72 | 524,956 | 289 |
| Kenosha, WI | $34.61 | $0.00 – $318.75 | 525,062 | 261 |
| Anniston, AL | $60.97 | $0.00 – $231.59 | 527,247 | 158 |
| Newburgh, NY | $75.78 | $0.00 – $189.48 | 527,986 | 183 |
| Lodi, CA | $12.71 | $0.00 – $722.51 | 529,183 | 107 |
| Mentor, OH | $35.59 | $11.91 – $345.00 | 529,557 | 177 |
| North Hollywood, CA | $13.71 | $0.00 – $1,064 | 532,033 | 101 |
| Northridge, CA | $37.01 | $0.00 – $1,233 | 534,807 | 209 |
| Sylmar, CA | $9.43 | $0.00 – $1,096 | 537,771 | 121 |
| Thibodaux, LA | $27.32 | $0.00 – $82.05 | 538,679 | 150 |
| Delano, CA | $33.93 | $0.00 – $602.84 | 538,856 | 63 |
| Parlier, CA | $1.62 | $0.14 – $65.61 | 539,060 | 18 |
| New Bedford, MA | $61.29 | $0.00 – $175.94 | 539,731 | 144 |
| Bayside, NY | $92.74 | $0.00 – $215.08 | 539,921 | 95 |
| Concord, CA | $70.91 | $0.00 – $901.69 | 540,713 | 162 |
| Norwalk, CT | $42.47 | $0.00 – $152.50 | 541,025 | 297 |
| Dover, DE | $55.49 | $0.00 – $180.46 | 541,196 | 252 |
| Quincy, IL | $20.64 | $0.00 – $152.73 | 541,776 | 213 |
| Beaumont, TX | $43.96 | $0.00 – $857.27 | 542,422 | 221 |
| Danville, KY | $37.86 | $0.00 – $101.88 | 543,022 | 158 |
| Panama City, FL | $45.61 | $0.00 – $224.35 | 544,963 | 296 |
| Rock Hill, SC | $74.20 | $0.00 – $346.42 | 545,668 | 240 |
| Dyersburg, TN | $36.77 | $0.00 – $91.79 | 545,818 | 93 |
| Hamtramck, MI | $66.26 | $2.93 – $94.76 | 546,212 | 28 |
| Germantown, TN | $47.56 | $0.00 – $155.75 | 547,470 | 333 |
| Boynton Beach, FL | $72.14 | $0.00 – $245.81 | 547,662 | 193 |
| Rocky Mount, NC | $53.06 | $0.00 – $449.30 | 549,209 | 216 |
| Huber Heights, OH | $56.38 | $9.88 – $95.90 | 550,212 | 55 |
| Springfield, OR | $51.80 | $0.52 – $568.18 | 550,547 | 339 |
| Jeffersonville, IN | $50.02 | $6.56 – $124.76 | 551,494 | 195 |
| Carolina, PR | $13.86 | $0.00 – $126.27 | 552,267 | 179 |
| Pembroke Pines, FL | $42.46 | $0.00 – $318.75 | 553,017 | 305 |
| Cary, NC | $61.34 | $0.00 – $296.83 | 555,520 | 377 |
| Lowell, MA | $51.92 | $0.00 – $191.68 | 557,559 | 235 |
| Macon, GA | $56.72 | $0.00 – $648.32 | 559,143 | 261 |
| Lancaster, OH | $50.30 | $0.03 – $328.85 | 559,428 | 209 |
| Mission Hills, CA | $22.78 | $0.00 – $221.84 | 559,607 | 173 |
| Hollywood, FL | $49.21 | $0.00 – $305.77 | 560,217 | 418 |
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.