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 |
|---|---|---|---|---|
| Morgantown, WV | $57.74 | $0.00 – $314.22 | 1,496,546 | 692 |
| Atlanta, GA | $65.00 | $0.00 – $919.84 | 1,497,277 | 1352 |
| Saginaw, MI | $53.47 | $0.00 – $261.37 | 1,506,630 | 206 |
| Chandler, AZ | $57.01 | $0.00 – $222.35 | 1,509,223 | 668 |
| Corpus Christi, TX | $51.31 | $0.00 – $283.10 | 1,532,281 | 467 |
| Houma, LA | $34.87 | $0.00 – $80.25 | 1,559,012 | 263 |
| Charlottesville, VA | $136.17 | $0.00 – $203.88 | 1,567,109 | 940 |
| Las Cruces, NM | $80.19 | $0.00 – $544.75 | 1,571,943 | 477 |
| Pittsburgh, PA | $58.11 | $0.00 – $735.11 | 1,594,344 | 1951 |
| Oxnard, CA | $49.83 | $0.00 – $570.86 | 1,598,076 | 337 |
| Huntington, WV | $42.90 | $0.00 – $262.13 | 1,599,438 | 585 |
| Edinburg, TX | $39.60 | $0.00 – $578.23 | 1,601,805 | 373 |
| Raleigh, NC | $59.24 | $0.00 – $324.90 | 1,603,097 | 1360 |
| Clifton, NJ | $56.80 | $0.00 – $253.08 | 1,620,787 | 287 |
| Metairie, LA | $38.14 | $0.00 – $179.97 | 1,636,120 | 483 |
| Des Moines, IA | $32.61 | $0.00 – $719.00 | 1,644,515 | 882 |
| Springfield, MO | $67.19 | $0.00 – $459.06 | 1,644,591 | 1103 |
| Tacoma, WA | $58.60 | $0.00 – $795.69 | 1,654,715 | 1199 |
| Syracuse, NY | $84.69 | $0.00 – $253.34 | 1,665,939 | 988 |
| Honolulu, HI | $72.77 | $0.00 – $611.42 | 1,673,860 | 1218 |
| Garden Grove, CA | $23.95 | $0.00 – $701.20 | 1,678,074 | 277 |
| Bowling Green, KY | $38.72 | $0.00 – $94.53 | 1,678,273 | 462 |
| Chattanooga, TN | $39.97 | $0.00 – $397.50 | 1,689,867 | 974 |
| Chula Vista, CA | $31.75 | $0.00 – $960.96 | 1,758,203 | 424 |
| Alexandria, LA | $29.10 | $0.00 – $137.42 | 1,764,439 | 405 |
| Norfolk, VA | $78.63 | $0.00 – $503.48 | 1,771,246 | 937 |
| Jersey City, NJ | $41.23 | $0.00 – $268.05 | 1,785,761 | 373 |
| Monroe, LA | $37.21 | $0.00 – $118.15 | 1,787,465 | 454 |
| Mcallen, TX | $34.30 | $0.00 – $876.52 | 1,812,622 | 467 |
| Glendale, CA | $16.01 | $0.00 – $1,233 | 1,840,187 | 576 |
| Providence, RI | $73.05 | $0.00 – $783.41 | 1,843,254 | 1198 |
| Ashland, KY | $34.13 | $0.00 – $148.91 | 1,844,265 | 352 |
| Kansas City, MO | $65.55 | $0.00 – $664.94 | 1,847,204 | 1615 |
| Omaha, NE | $62.03 | $0.00 – $323.92 | 1,855,047 | 1824 |
| Lake Charles, LA | $37.10 | $0.00 – $98.72 | 1,856,511 | 494 |
| Ventura, CA | $38.51 | $0.00 – $947.86 | 1,869,199 | 448 |
| Ann Arbor, MI | $55.32 | $0.00 – $263.93 | 1,878,500 | 365 |
| Brownsville, TX | $29.00 | $0.00 – $222.74 | 1,881,728 | 220 |
| Hartford, CT | $38.58 | $0.00 – $208.74 | 1,919,956 | 1234 |
| Madera, CA | $24.94 | $0.00 – $841.05 | 1,930,557 | 312 |
| Glendale, AZ | $53.43 | $0.00 – $393.95 | 1,961,705 | 703 |
| Birmingham, AL | $74.46 | $0.00 – $1,873 | 1,976,328 | 1437 |
| Yuma, AZ | $50.03 | $0.00 – $157.39 | 1,989,010 | 370 |
| Jacksonville, FL | $49.45 | $0.00 – $445.87 | 2,026,145 | 1537 |
| Worcester, MA | $63.47 | $0.00 – $226.96 | 2,032,687 | 1521 |
| New Haven, CT | $40.00 | $0.00 – $254.47 | 2,069,086 | 1484 |
| Winston Salem, NC | $56.55 | $0.00 – $686.81 | 2,112,661 | 1492 |
| Orange, CA | $52.01 | $0.00 – $1,181 | 2,116,805 | 991 |
| Fayetteville, NC | $49.95 | $0.00 – $722.10 | 2,128,316 | 699 |
| Staten Island, NY | $79.09 | $0.00 – $241.84 | 2,187,504 | 931 |
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.