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 |
|---|---|---|---|---|
| Bethlehem, PA | $40.61 | $0.00 – $208.78 | 336,752 | 412 |
| Ashtabula, OH | $40.79 | $9.74 – $791.60 | 336,724 | 79 |
| Decatur, AL | $39.95 | $0.00 – $206.31 | 336,311 | 166 |
| Savannah, GA | $87.99 | $0.00 – $318.75 | 336,033 | 210 |
| Elmira, NY | $87.85 | $0.00 – $265.23 | 335,094 | 173 |
| Englewood, NJ | $53.45 | $0.13 – $112.83 | 334,797 | 173 |
| Eunice, LA | $27.07 | $0.00 – $62.12 | 334,012 | 44 |
| Lapeer, MI | $60.15 | $0.00 – $150.01 | 333,737 | 40 |
| Woodland, CA | $23.40 | $0.00 – $1,348 | 333,345 | 174 |
| Maysville, KY | $35.65 | $0.00 – $318.75 | 333,323 | 86 |
| Edmond, OK | $90.89 | $0.00 – $662.08 | 333,239 | 311 |
| Bay Shore, NY | $74.31 | $1.20 – $219.64 | 333,039 | 176 |
| Oxford, MS | $48.82 | $0.00 – $177.89 | 332,785 | 186 |
| Hicksville, NY | $88.60 | $11.54 – $178.70 | 332,405 | 74 |
| Cordova, TN | $37.29 | $0.00 – $191.12 | 332,405 | 121 |
| Norwood, MA | $59.72 | $0.00 – $145.63 | 332,318 | 124 |
| St Louis Park, MN | $64.83 | $0.82 – $261.03 | 332,284 | 378 |
| Clearwater, FL | $43.07 | $0.00 – $211.09 | 331,263 | 229 |
| Newport, TN | $39.31 | $3.15 – $70.42 | 330,736 | 78 |
| Yorktown Heights, NY | $98.77 | $1.37 – $204.18 | 330,538 | 62 |
| Sun City, AZ | $55.01 | $1.34 – $122.83 | 330,484 | 130 |
| Kansas City, KS | $71.82 | $0.00 – $550.88 | 329,507 | 451 |
| Lynn, MA | $56.35 | $0.00 – $165.49 | 329,489 | 127 |
| Enfield, CT | $46.95 | $0.28 – $99.61 | 328,865 | 141 |
| Woonsocket, RI | $53.32 | $0.00 – $127.10 | 327,843 | 153 |
| Carmichael, CA | $13.38 | $0.00 – $420.46 | 326,983 | 149 |
| Columbus, MS | $47.10 | $0.00 – $327.75 | 326,303 | 168 |
| Greenville, MS | $48.02 | $0.00 – $292.79 | 326,256 | 124 |
| Marlton, NJ | $64.25 | $0.00 – $175.81 | 326,225 | 196 |
| Minden, LA | $27.94 | $0.00 – $91.71 | 325,653 | 55 |
| Beavercreek, OH | $44.59 | $13.32 – $97.72 | 325,168 | 221 |
| Covina, CA | $41.94 | $0.00 – $1,165 | 324,704 | 151 |
| Clinton Twp, MI | $141.00 | $4.38 – $291.10 | 324,696 | 27 |
| Marion, IN | $55.91 | $2.25 – $112.44 | 324,360 | 114 |
| Elkhart, IN | $49.36 | $8.49 – $256.77 | 323,807 | 178 |
| Bardstown, KY | $39.53 | $4.85 – $76.74 | 323,569 | 108 |
| Fair Lawn, NJ | $55.98 | $0.00 – $154.69 | 323,172 | 106 |
| Easton, MD | $84.78 | $0.91 – $181.92 | 322,709 | 188 |
| Lancaster, SC | $69.40 | $4.75 – $216.87 | 322,561 | 85 |
| Augusta, ME | $39.94 | $1.50 – $190.05 | 321,589 | 250 |
| Shelbyville, TN | $37.69 | $1.74 – $79.57 | 321,501 | 54 |
| Johnstown, PA | $48.32 | $0.00 – $190.03 | 320,949 | 181 |
| East Brunswick, NJ | $60.03 | $0.94 – $214.14 | 320,866 | 124 |
| Cape Girardeau, MO | $49.51 | $1.27 – $558.24 | 320,729 | 318 |
| Moline, IL | $44.99 | $0.00 – $593.46 | 320,322 | 182 |
| Fort Dodge, IA | $18.59 | $0.00 – $283.75 | 319,826 | 104 |
| Vacaville, CA | $21.23 | $0.00 – $685.28 | 317,722 | 152 |
| Tarzana, CA | $30.55 | $0.00 – $653.79 | 317,173 | 145 |
| Aiken, SC | $69.54 | $0.57 – $253.19 | 317,075 | 138 |
| Parma, OH | $47.35 | $0.00 – $318.75 | 316,646 | 152 |
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.