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 |
|---|---|---|---|---|
| New London, CT | $35.67 | $0.00 – $107.25 | 472,853 | 210 |
| Wheeling, WV | $51.57 | $0.00 – $153.33 | 471,387 | 208 |
| Asheboro, NC | $58.93 | $0.00 – $85.60 | 471,359 | 149 |
| Amarillo, TX | $44.15 | $0.00 – $164.54 | 471,116 | 319 |
| Gonzales, LA | $37.65 | $0.00 – $90.16 | 471,075 | 122 |
| West Des Moines, IA | $38.86 | $0.00 – $308.90 | 471,042 | 372 |
| Tyler, TX | $44.43 | $0.00 – $329.03 | 469,139 | 418 |
| Federal Way, WA | $49.48 | $0.00 – $221.74 | 468,887 | 288 |
| Dartmouth, MA | $45.59 | $1.51 – $103.28 | 468,875 | 203 |
| San Ysidro, CA | $1.76 | $0.00 – $86.32 | 467,413 | 59 |
| Brawley, CA | $23.29 | $0.00 – $871.01 | 467,188 | 75 |
| Bristol, CT | $47.83 | $0.00 – $143.63 | 467,078 | 186 |
| Sandusky, OH | $42.41 | $0.00 – $187.60 | 466,031 | 211 |
| Appleton, WI | $33.88 | $0.00 – $150.50 | 465,504 | 458 |
| Utica, NY | $81.63 | $0.00 – $295.37 | 464,991 | 242 |
| Hayward, CA | $18.68 | $0.00 – $979.66 | 463,487 | 158 |
| Renton, WA | $49.85 | $0.00 – $236.13 | 462,108 | 394 |
| Michigan City, IN | $56.30 | $0.00 – $256.51 | 461,375 | 161 |
| Maywood, IL | $52.95 | $0.00 – $318.75 | 460,729 | 424 |
| Burlington, NC | $61.14 | $0.00 – $162.38 | 459,965 | 253 |
| Brandon, FL | $47.61 | $0.00 – $489.92 | 459,044 | 226 |
| New Bern, NC | $53.40 | $0.00 – $129.22 | 456,547 | 265 |
| Sugar Land, TX | $54.52 | $0.00 – $318.75 | 456,215 | 304 |
| Natchitoches, LA | $27.27 | $0.00 – $55.73 | 455,730 | 92 |
| West Sacramento, CA | $7.58 | $0.00 – $717.27 | 455,036 | 54 |
| Monroe, NC | $61.13 | $0.00 – $99.37 | 453,263 | 212 |
| Mishawaka, IN | $54.11 | $0.00 – $265.92 | 452,845 | 203 |
| Carbondale, IL | $12.72 | $0.00 – $132.02 | 451,954 | 136 |
| Suffolk, VA | $44.97 | $9.47 – $172.67 | 451,809 | 277 |
| Council Bluffs, IA | $35.12 | $0.51 – $175.48 | 451,392 | 187 |
| Warsaw, IN | $70.29 | $0.00 – $106.07 | 449,967 | 101 |
| Ukiah, CA | $19.34 | $0.00 – $394.60 | 448,846 | 121 |
| Meriden, CT | $34.41 | $0.00 – $127.23 | 448,398 | 153 |
| West Bloomfield, MI | $82.12 | $0.00 – $88.82 | 448,300 | 44 |
| Lawrenceburg, TN | $38.20 | $0.00 – $79.50 | 448,047 | 108 |
| Crossville, TN | $35.12 | $0.00 – $165.96 | 447,797 | 122 |
| Paramount, CA | $12.18 | $0.00 – $411.64 | 447,001 | 62 |
| Far Rockaway, NY | $78.30 | $0.33 – $202.97 | 446,916 | 127 |
| Norman, OK | $86.82 | $0.00 – $655.89 | 446,421 | 316 |
| Moses Lake, WA | $42.21 | $0.00 – $330.49 | 446,298 | 170 |
| North Las Vegas, NV | $54.88 | $0.00 – $334.79 | 446,215 | 176 |
| Bossier City, LA | $33.22 | $0.00 – $112.03 | 446,163 | 132 |
| Bristol, TN | $43.50 | $3.33 – $146.13 | 445,419 | 206 |
| Lewiston, ME | $35.50 | $0.00 – $165.04 | 444,176 | 274 |
| Leesburg, VA | $44.10 | $0.00 – $121.35 | 442,434 | 185 |
| West New York, NJ | $32.72 | $0.38 – $199.74 | 442,015 | 69 |
| Cooperstown, NY | $117.93 | $3.46 – $136.87 | 441,758 | 173 |
| Sanger, CA | $2.11 | $0.00 – $175.77 | 441,532 | 34 |
| Southaven, MS | $47.91 | $0.00 – $146.12 | 440,863 | 174 |
| San Gabriel, CA | $17.47 | $0.00 – $200.00 | 440,578 | 113 |
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.