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 |
|---|---|---|---|---|
| Bangor, ME | $27.57 | $0.00 – $120.67 | 683,589 | 483 |
| Richmond, KY | $36.72 | $12.02 – $72.89 | 689,221 | 159 |
| Fort Smith, AR | $61.69 | $0.00 – $719.00 | 691,562 | 401 |
| Mission, TX | $31.88 | $0.00 – $110.61 | 692,221 | 108 |
| Roswell, NM | $77.78 | $1.36 – $297.59 | 693,627 | 162 |
| Poughkeepsie, NY | $92.42 | $0.00 – $272.75 | 701,126 | 390 |
| Vallejo, CA | $19.51 | $0.00 – $1,124 | 706,741 | 250 |
| Newark, DE | $54.53 | $0.00 – $479.00 | 707,386 | 451 |
| Kenner, LA | $34.71 | $0.00 – $534.92 | 707,827 | 149 |
| Gardena, CA | $41.60 | $0.00 – $1,233 | 711,935 | 169 |
| Lafayette, IN | $56.15 | $0.00 – $143.70 | 714,113 | 438 |
| Hempstead, NY | $20.66 | $3.94 – $166.43 | 714,500 | 76 |
| Upland, CA | $44.57 | $0.00 – $1,201 | 715,468 | 213 |
| Fredericksburg, VA | $59.68 | $0.00 – $270.05 | 716,193 | 443 |
| Santa Barbara, CA | $76.65 | $0.00 – $8,084 | 716,450 | 468 |
| Bend, OR | $41.72 | $0.00 – $671.07 | 718,671 | 680 |
| Greenwood, IN | $58.69 | $0.00 – $109.98 | 719,472 | 349 |
| Galveston, TX | $66.93 | $0.00 – $202.93 | 720,968 | 355 |
| Schenectady, NY | $74.00 | $0.00 – $240.96 | 721,379 | 338 |
| Lawrence, MA | $45.78 | $0.00 – $165.49 | 722,961 | 249 |
| El Monte, CA | $9.42 | $0.00 – $1,017 | 727,741 | 136 |
| Panorama City, CA | $19.79 | $0.00 – $834.66 | 728,375 | 331 |
| Kennewick, WA | $55.16 | $0.19 – $155.85 | 731,101 | 239 |
| Temecula, CA | $30.45 | $0.00 – $1,918 | 731,207 | 204 |
| White Plains, NY | $83.23 | $0.00 – $206.58 | 731,348 | 314 |
| Iowa City, IA | $49.62 | $0.00 – $334.44 | 731,963 | 943 |
| Olympia, WA | $56.13 | $0.00 – $536.14 | 734,393 | 550 |
| Manchester, NH | $37.99 | $0.00 – $469.04 | 737,132 | 535 |
| Bel Air, MD | $87.64 | $0.00 – $228.29 | 738,961 | 260 |
| Waterloo, IA | $28.16 | $0.00 – $259.98 | 739,153 | 354 |
| Barbourville, KY | $31.06 | $7.96 – $59.01 | 740,254 | 77 |
| Hackensack, NJ | $57.18 | $0.03 – $228.02 | 743,791 | 395 |
| Davenport, IA | $24.91 | $0.00 – $123.00 | 745,465 | 265 |
| South Charleston, WV | $57.79 | $0.00 – $130.86 | 745,810 | 159 |
| Surprise, AZ | $49.61 | $0.00 – $170.23 | 746,261 | 217 |
| National City, CA | $22.17 | $0.00 – $137.25 | 747,320 | 137 |
| Sioux City, IA | $30.79 | $0.00 – $310.09 | 749,417 | 273 |
| Anderson, SC | $61.81 | $4.25 – $171.78 | 750,373 | 307 |
| Muncie, IN | $58.81 | $0.00 – $462.66 | 752,762 | 342 |
| Edison, NJ | $46.03 | $1.38 – $189.29 | 753,071 | 266 |
| Goldsboro, NC | $52.64 | $0.00 – $302.49 | 755,846 | 231 |
| Pharr, TX | $33.77 | $0.00 – $695.76 | 758,543 | 57 |
| Frederick, MD | $90.91 | $0.00 – $319.84 | 760,250 | 472 |
| Danville, VA | $42.81 | $0.71 – $375.97 | 763,706 | 202 |
| Morehead, KY | $32.41 | $5.84 – $76.71 | 764,621 | 149 |
| Green Bay, WI | $38.55 | $0.00 – $426.43 | 766,749 | 722 |
| Toms River, NJ | $39.86 | $0.00 – $233.31 | 767,181 | 264 |
| Manati, PR | $25.46 | $0.00 – $132.41 | 767,236 | 217 |
| Pensacola, FL | $44.16 | $0.00 – $1,535 | 768,378 | 689 |
| Billings, MT | $76.66 | $0.00 – $528.57 | 769,144 | 511 |
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.