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 |
|---|---|---|---|---|
| Sumter, SC | $76.88 | $0.00 – $345.00 | 592,225 | 199 |
| Madisonville, KY | $36.41 | $10.82 – $81.89 | 590,572 | 164 |
| Alhambra, CA | $22.80 | $0.00 – $923.86 | 590,046 | 172 |
| Costa Mesa, CA | $53.36 | $0.00 – $1,088 | 588,622 | 113 |
| Newport Beach, CA | $40.13 | $0.00 – $291.43 | 588,212 | 237 |
| Hot Springs, AR | $38.70 | $0.00 – $307.05 | 586,740 | 270 |
| Hilliard, OH | $43.11 | $0.64 – $305.81 | 586,336 | 167 |
| Westerville, OH | $58.21 | $1.86 – $322.61 | 585,772 | 377 |
| Los Banos, CA | $21.12 | $0.00 – $956.98 | 585,391 | 53 |
| Tustin, CA | $37.27 | $0.00 – $1,405 | 584,488 | 132 |
| Gaithersburg, MD | $81.43 | $-0.23 – $206.02 | 583,421 | 234 |
| Port Huron, MI | $72.30 | $4.79 – $229.47 | 582,814 | 56 |
| La Crosse, WI | $52.54 | $0.00 – $455.50 | 582,675 | 507 |
| Colton, CA | $32.30 | $0.00 – $994.07 | 582,383 | 275 |
| Manassas, VA | $61.44 | $0.00 – $299.63 | 582,362 | 286 |
| Lorain, OH | $42.76 | $0.00 – $318.75 | 582,044 | 235 |
| Laurel, MD | $85.55 | $0.00 – $239.94 | 581,859 | 198 |
| Goodyear, AZ | $47.32 | $0.00 – $164.78 | 579,074 | 207 |
| Murrieta, CA | $21.08 | $0.00 – $413.59 | 577,347 | 212 |
| Walnut Creek, CA | $52.12 | $0.00 – $286.96 | 574,424 | 454 |
| Roseburg, OR | $60.26 | $0.30 – $685.66 | 572,035 | 242 |
| Union City, NJ | $41.85 | $0.00 – $102.74 | 571,711 | 95 |
| Oak Park, IL | $11.15 | $0.00 – $245.23 | 571,533 | 144 |
| Livingston, NJ | $86.71 | $3.67 – $226.90 | 570,991 | 153 |
| Scranton, PA | $32.17 | $0.00 – $508.72 | 570,589 | 260 |
| Calexico, CA | $17.74 | $0.00 – $863.80 | 570,223 | 46 |
| Stanford, CA | $35.97 | $0.00 – $1,093 | 570,196 | 655 |
| Leesville, LA | $23.43 | $0.00 – $53.97 | 569,942 | 65 |
| Inglewood, CA | $31.77 | $0.00 – $745.39 | 568,376 | 175 |
| Idaho Falls, ID | $61.52 | $0.00 – $146.99 | 566,749 | 371 |
| Puyallup, WA | $62.15 | $0.00 – $358.29 | 565,936 | 366 |
| Lexington, SC | $71.88 | $4.06 – $338.01 | 565,550 | 184 |
| York, PA | $45.53 | $0.00 – $181.98 | 564,277 | 565 |
| Casa Grande, AZ | $34.25 | $0.00 – $113.53 | 562,929 | 115 |
| Hollywood, FL | $49.21 | $0.00 – $305.77 | 560,217 | 418 |
| Mission Hills, CA | $22.78 | $0.00 – $221.84 | 559,607 | 173 |
| Lancaster, OH | $50.30 | $0.03 – $328.85 | 559,428 | 209 |
| Macon, GA | $56.72 | $0.00 – $648.32 | 559,143 | 261 |
| Lowell, MA | $51.92 | $0.00 – $191.68 | 557,559 | 235 |
| Cary, NC | $61.34 | $0.00 – $296.83 | 555,520 | 377 |
| Pembroke Pines, FL | $42.46 | $0.00 – $318.75 | 553,017 | 305 |
| Carolina, PR | $13.86 | $0.00 – $126.27 | 552,267 | 179 |
| Jeffersonville, IN | $50.02 | $6.56 – $124.76 | 551,494 | 195 |
| Springfield, OR | $51.80 | $0.52 – $568.18 | 550,547 | 339 |
| Huber Heights, OH | $56.38 | $9.88 – $95.90 | 550,212 | 55 |
| Rocky Mount, NC | $53.06 | $0.00 – $449.30 | 549,209 | 216 |
| Boynton Beach, FL | $72.14 | $0.00 – $245.81 | 547,662 | 193 |
| Germantown, TN | $47.56 | $0.00 – $155.75 | 547,470 | 333 |
| Hamtramck, MI | $66.26 | $2.93 – $94.76 | 546,212 | 28 |
| Dyersburg, TN | $36.77 | $0.00 – $91.79 | 545,818 | 93 |
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.