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 |
|---|---|---|---|---|
| Bayonne, NJ | $47.95 | $0.00 – $132.51 | 440,328 | 102 |
| Hillsboro, OR | $60.33 | $0.00 – $534.78 | 438,239 | 345 |
| Oak Ridge, TN | $40.42 | $0.60 – $292.24 | 437,896 | 191 |
| Sewell, NJ | $54.69 | $0.00 – $191.58 | 437,803 | 225 |
| Mesquite, TX | $36.14 | $0.00 – $254.40 | 437,606 | 104 |
| Summerville, SC | $69.06 | $7.97 – $662.18 | 437,056 | 228 |
| Vineland, NJ | $39.30 | $0.00 – $193.37 | 436,641 | 167 |
| Bogalusa, LA | $30.76 | $0.00 – $115.15 | 436,239 | 78 |
| Conway, SC | $81.21 | $7.95 – $224.27 | 435,995 | 188 |
| Bellflower, CA | $21.71 | $0.00 – $1,018 | 435,957 | 327 |
| Palmdale, CA | $50.35 | $0.00 – $1,220 | 435,518 | 173 |
| Amherst, NY | $70.26 | $0.00 – $220.38 | 432,666 | 269 |
| Naperville, IL | $57.32 | $0.00 – $225.98 | 432,516 | 344 |
| Burlington, VT | $27.27 | $0.00 – $234.12 | 432,379 | 448 |
| Neptune, NJ | $70.63 | $0.00 – $172.56 | 431,267 | 207 |
| Hobbs, NM | $78.01 | $0.00 – $173.50 | 430,493 | 57 |
| Flagstaff, AZ | $49.29 | $0.00 – $312.18 | 429,684 | 327 |
| Campbellsville, KY | $32.87 | $6.08 – $59.80 | 429,578 | 91 |
| Eau Claire, WI | $37.36 | $0.00 – $187.89 | 429,148 | 464 |
| North Bergen, NJ | $47.13 | $0.58 – $123.07 | 428,138 | 106 |
| Mineola, NY | $88.52 | $0.00 – $239.22 | 427,856 | 244 |
| Peekskill, NY | $140.14 | $0.00 – $171.35 | 426,921 | 41 |
| Bay City, MI | $71.05 | $0.00 – $227.27 | 425,745 | 62 |
| Smithfield, NC | $60.65 | $0.00 – $106.01 | 425,345 | 146 |
| Paramus, NJ | $62.93 | $0.00 – $321.22 | 425,290 | 147 |
| Fargo, ND | $90.52 | $0.00 – $737.12 | 424,739 | 624 |
| Saint Joseph, MO | $48.45 | $0.00 – $113.96 | 421,950 | 224 |
| Dearborn Heights, MI | $70.65 | $7.92 – $111.02 | 421,811 | 49 |
| Champaign, IL | $41.19 | $0.00 – $137.07 | 421,373 | 275 |
| Perth Amboy, NJ | $39.35 | $0.00 – $114.98 | 421,141 | 84 |
| Marshfield, WI | $54.01 | $0.00 – $117.28 | 420,848 | 233 |
| Newnan, GA | $102.52 | $2.92 – $166.64 | 419,852 | 82 |
| East Hartford, CT | $37.41 | $0.00 – $92.90 | 419,493 | 98 |
| Wayne, NJ | $48.44 | $0.00 – $143.03 | 418,690 | 172 |
| Williamsville, NY | $63.94 | $3.64 – $160.34 | 418,439 | 514 |
| East Lansing, MI | $55.78 | $0.73 – $671.71 | 416,926 | 92 |
| Odessa, TX | $42.33 | $0.00 – $113.56 | 416,560 | 182 |
| Encino, CA | $36.70 | $0.00 – $147.94 | 416,535 | 169 |
| Shafter, CA | $29.18 | $0.00 – $84.96 | 415,522 | 33 |
| Grants Pass, OR | $32.36 | $0.00 – $316.07 | 414,874 | 236 |
| Searcy, AR | $36.69 | $0.00 – $123.74 | 414,837 | 142 |
| Laurel, MS | $53.78 | $0.00 – $121.53 | 413,282 | 186 |
| San Luis, AZ | $11.99 | $0.01 – $133.60 | 413,167 | 36 |
| Winchester, KY | $35.56 | $0.00 – $70.79 | 412,606 | 98 |
| Danville, IL | $15.86 | $0.00 – $130.99 | 412,049 | 103 |
| Meridian, ID | $59.93 | $0.00 – $202.98 | 410,513 | 399 |
| Lebanon, NH | $49.15 | $0.00 – $477.05 | 410,188 | 567 |
| Napa, CA | $27.44 | $0.00 – $1,023 | 409,277 | 211 |
| Abbeville, LA | $18.27 | $0.00 – $87.64 | 408,938 | 51 |
| Southgate, MI | $68.11 | $2.26 – $95.96 | 408,900 | 41 |
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.