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 |
|---|---|---|---|---|
| Thousand Oaks, CA | $48.23 | $0.00 – $950.10 | 506,214 | 112 |
| Richland, WA | $50.92 | $0.00 – $456.19 | 505,762 | 316 |
| Beverly Hills, CA | $49.91 | $0.00 – $623.59 | 505,527 | 300 |
| Decatur, IL | $24.65 | $0.00 – $101.24 | 505,157 | 222 |
| Salisbury, NC | $61.24 | $0.00 – $169.84 | 504,467 | 208 |
| New Albany, IN | $51.70 | $0.00 – $318.75 | 504,337 | 230 |
| Midland, MI | $56.60 | $0.88 – $247.76 | 503,950 | 57 |
| Columbus, IN | $54.12 | $0.00 – $98.64 | 503,010 | 260 |
| Taylor, MI | $60.91 | $0.00 – $92.81 | 501,505 | 60 |
| Bridgeport, WV | $53.99 | $0.00 – $144.19 | 500,743 | 172 |
| Holyoke, MA | $62.81 | $0.75 – $165.49 | 500,498 | 171 |
| Ironton, OH | $43.46 | $0.60 – $145.78 | 500,465 | 65 |
| Eureka, CA | $32.25 | $0.00 – $878.88 | 499,776 | 168 |
| Fresh Meadows, NY | $73.33 | $0.00 – $165.44 | 499,483 | 136 |
| Fairfield, CT | $49.81 | $0.00 – $138.69 | 498,734 | 244 |
| Great Falls, MT | $69.01 | $0.00 – $407.57 | 498,486 | 290 |
| Ontario, CA | $37.92 | $0.00 – $1,784 | 498,039 | 115 |
| Manchester, KY | $31.36 | $0.65 – $65.11 | 497,241 | 67 |
| Hampton, VA | $59.16 | $0.00 – $160.24 | 496,065 | 298 |
| Racine, WI | $39.50 | $0.00 – $65.34 | 493,194 | 103 |
| Melbourne, FL | $46.75 | $0.00 – $345.38 | 492,716 | 325 |
| Huntington Park, CA | $15.53 | $0.00 – $1,224 | 492,480 | 141 |
| Greeley, CO | $90.71 | $0.00 – $676.19 | 491,493 | 336 |
| Middletown, OH | $51.46 | $0.48 – $113.78 | 490,917 | 160 |
| Trenton, NJ | $42.14 | $0.00 – $200.60 | 490,743 | 157 |
| Longview, WA | $63.28 | $0.00 – $240.41 | 490,282 | 232 |
| Simi Valley, CA | $25.22 | $0.00 – $933.89 | 489,366 | 125 |
| Livonia, MI | $65.28 | $0.01 – $103.91 | 487,722 | 109 |
| Arlington, VA | $47.67 | $0.00 – $315.80 | 487,162 | 273 |
| Abingdon, VA | $55.20 | $1.01 – $131.47 | 485,494 | 189 |
| New Hartford, NY | $76.60 | $5.50 – $149.21 | 481,682 | 236 |
| Warwick, RI | $57.76 | $0.00 – $357.47 | 480,077 | 319 |
| Frankfort, KY | $38.45 | $1.13 – $92.81 | 479,125 | 128 |
| Ruston, LA | $25.86 | $0.00 – $67.80 | 478,290 | 107 |
| Tracy, CA | $37.81 | $0.00 – $1,083 | 478,225 | 110 |
| Hamilton, NJ | $51.75 | $0.00 – $220.62 | 477,985 | 187 |
| Myrtle Beach, SC | $72.83 | $0.00 – $214.35 | 476,951 | 300 |
| Tallahassee, FL | $59.17 | $0.00 – $207.45 | 476,699 | 481 |
| Greenwood, SC | $74.96 | $0.00 – $289.93 | 476,567 | 225 |
| Dalton, GA | $56.33 | $1.35 – $207.41 | 476,456 | 164 |
| Waco, TX | $45.75 | $0.00 – $522.89 | 476,451 | 315 |
| Boardman, OH | $53.32 | $2.58 – $163.26 | 476,256 | 183 |
| Watertown, NY | $79.05 | $0.00 – $147.24 | 475,797 | 198 |
| Whittier, CA | $22.68 | $0.00 – $1,005 | 475,782 | 215 |
| Jamestown, NY | $64.25 | $0.00 – $165.30 | 475,724 | 150 |
| Twin Falls, ID | $57.25 | $0.00 – $300.78 | 475,696 | 287 |
| Cherry Hill, NJ | $68.69 | $0.00 – $298.85 | 475,643 | 339 |
| Topeka, KS | $39.72 | $0.00 – $312.32 | 474,860 | 514 |
| Humacao, PR | $14.01 | $0.00 – $100.33 | 474,658 | 151 |
| Midlothian, VA | $60.31 | $0.51 – $127.11 | 473,027 | 259 |
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.