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 |
|---|---|---|---|---|
| Hendersonville, NC | $56.83 | $0.00 – $569.86 | 408,760 | 259 |
| Lake City, FL | $34.35 | $0.00 – $127.23 | 407,793 | 101 |
| Taunton, MA | $67.37 | $0.00 – $160.18 | 407,318 | 155 |
| Skokie, IL | $45.81 | $0.00 – $592.88 | 406,799 | 279 |
| Torrington, CT | $49.62 | $0.00 – $166.57 | 406,131 | 168 |
| Nashua, NH | $39.11 | $0.00 – $279.05 | 405,622 | 385 |
| Tuscaloosa, AL | $50.83 | $0.00 – $222.14 | 405,524 | 289 |
| Katy, TX | $47.29 | $0.00 – $137.61 | 404,788 | 230 |
| Rosemead, CA | $13.57 | $0.00 – $653.45 | 403,748 | 81 |
| Murray, KY | $37.20 | $7.94 – $279.42 | 402,279 | 118 |
| Prescott, AZ | $57.61 | $0.14 – $390.52 | 401,335 | 245 |
| Plano, TX | $42.11 | $0.00 – $189.04 | 400,639 | 283 |
| La Jolla, CA | $47.42 | $0.00 – $224.91 | 400,355 | 283 |
| Kalispell, MT | $72.03 | $0.00 – $219.48 | 400,343 | 314 |
| Hartsville, SC | $66.64 | $9.83 – $326.57 | 399,951 | 77 |
| Waldorf, MD | $84.46 | $0.00 – $232.76 | 399,687 | 214 |
| Marietta, OH | $53.91 | $5.02 – $116.90 | 398,739 | 197 |
| Jackson, KY | $32.51 | $0.00 – $58.57 | 398,710 | 51 |
| West Columbia, SC | $56.33 | $0.00 – $240.39 | 398,202 | 345 |
| Clinton Township, MI | $59.84 | $5.39 – $675.58 | 398,073 | 56 |
| Floral Park, NY | $51.98 | $0.00 – $129.56 | 396,757 | 37 |
| Martinsville, VA | $58.73 | $0.00 – $135.24 | 396,698 | 110 |
| Valparaiso, IN | $59.36 | $0.00 – $147.18 | 396,607 | 200 |
| Mount Airy, NC | $47.81 | $0.00 – $95.54 | 395,164 | 121 |
| Concord, NH | $41.62 | $0.00 – $214.12 | 393,759 | 376 |
| Guaynabo, PR | $21.25 | $0.00 – $138.08 | 393,125 | 147 |
| Conway, AR | $42.64 | $0.00 – $464.64 | 392,014 | 187 |
| Livingston, CA | $16.48 | $0.00 – $83.47 | 391,749 | 18 |
| West Monroe, LA | $34.93 | $0.00 – $123.10 | 391,404 | 114 |
| Smyrna, TN | $39.51 | $3.69 – $76.42 | 391,282 | 138 |
| Monroe, MI | $68.45 | $2.19 – $183.00 | 391,016 | 78 |
| Lakewood, CO | $72.47 | $0.00 – $374.93 | 390,812 | 339 |
| Wauconda, IL | $54.08 | $38.77 – $86.12 | 389,992 | 31 |
| Gresham, OR | $64.51 | $0.00 – $231.67 | 389,769 | 187 |
| Pawtucket, RI | $58.11 | $0.00 – $132.55 | 389,301 | 200 |
| Gallatin, TN | $40.54 | $0.80 – $77.92 | 388,382 | 142 |
| Pleasanton, CA | $33.17 | $0.00 – $1,017 | 388,049 | 146 |
| Georgetown, KY | $38.80 | $5.22 – $112.83 | 387,461 | 115 |
| Kingman, AZ | $45.06 | $0.00 – $120.19 | 386,556 | 153 |
| San Rafael, CA | $11.51 | $0.00 – $875.55 | 386,259 | 120 |
| Atwater, CA | $27.94 | $0.00 – $84.30 | 386,111 | 26 |
| Goshen, IN | $69.06 | $0.00 – $149.02 | 382,179 | 194 |
| Mount Vernon, OH | $50.32 | $0.00 – $135.44 | 381,559 | 118 |
| Amsterdam, NY | $78.01 | $0.00 – $133.18 | 381,405 | 106 |
| Lynwood, CA | $22.51 | $0.00 – $918.36 | 379,618 | 119 |
| Harrisburg, PA | $39.02 | $0.00 – $251.30 | 379,411 | 297 |
| Orangeburg, SC | $70.38 | $0.00 – $248.56 | 378,915 | 158 |
| Lakewood, WA | $51.54 | $0.00 – $178.25 | 378,652 | 159 |
| Williamsburg, VA | $67.00 | $15.24 – $142.47 | 378,404 | 198 |
| West Hartford, CT | $45.66 | $0.00 – $116.56 | 378,248 | 213 |
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.