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 |
|---|---|---|---|---|
| La Habra, CA | $26.58 | $0.00 – $120.00 | 303,375 | 51 |
| Russellville, AR | $38.39 | $0.57 – $122.81 | 303,011 | 107 |
| Cathedral City, CA | $8.74 | $0.00 – $125.05 | 302,971 | 49 |
| Winnsboro, LA | $16.64 | $0.00 – $84.52 | 302,567 | 54 |
| Troy, MI | $70.06 | $1.94 – $268.41 | 302,479 | 89 |
| Suffern, NY | $75.83 | $0.00 – $202.09 | 301,758 | 98 |
| Bedford, IN | $61.21 | $0.07 – $100.44 | 300,770 | 79 |
| Leominster, MA | $74.91 | $1.29 – $444.86 | 300,728 | 172 |
| Mechanicsville, VA | $59.33 | $3.98 – $128.54 | 300,582 | 199 |
| Hershey, PA | $62.32 | $0.00 – $374.99 | 300,551 | 483 |
| West Haven, CT | $50.44 | $0.00 – $112.26 | 300,132 | 112 |
| Selma, AL | $75.86 | $0.00 – $227.84 | 299,739 | 68 |
| Germantown, MD | $80.18 | $0.00 – $182.63 | 299,321 | 122 |
| Humble, TX | $47.26 | $0.00 – $271.32 | 298,828 | 117 |
| Buena Park, CA | $38.83 | $0.17 – $305.11 | 298,820 | 63 |
| Greenfield, WI | $35.12 | $12.31 – $229.92 | 298,391 | 168 |
| Lawton, OK | $56.63 | $0.00 – $664.27 | 298,280 | 194 |
| Natchez, MS | $48.78 | $0.00 – $115.90 | 298,238 | 81 |
| King City, CA | $12.65 | $0.00 – $634.47 | 298,073 | 23 |
| Lewisville, TX | $41.97 | $0.11 – $613.23 | 297,601 | 68 |
| Hatch, NM | $178.63 | $58.50 – $210.75 | 297,429 | 8 |
| Sevierville, TN | $41.69 | $1.17 – $101.76 | 296,351 | 116 |
| Biloxi, MS | $44.24 | $0.00 – $122.95 | 296,052 | 156 |
| Mooresville, NC | $57.41 | $0.00 – $115.71 | 295,962 | 246 |
| Southern Pines, NC | $59.59 | $4.18 – $111.42 | 295,782 | 99 |
| Savannah, TN | $31.04 | $3.27 – $58.62 | 295,488 | 62 |
| Nogales, AZ | $20.46 | $0.00 – $101.15 | 295,331 | 39 |
| Greer, SC | $64.48 | $6.90 – $229.83 | 295,285 | 161 |
| Guayama, PR | $20.93 | $0.00 – $96.67 | 295,105 | 89 |
| Vicksburg, MS | $64.93 | $4.84 – $156.49 | 294,964 | 98 |
| Oregon, OH | $47.69 | $0.00 – $135.99 | 294,677 | 139 |
| Ceres, CA | $9.80 | $0.00 – $359.69 | 294,398 | 32 |
| Conroe, TX | $49.17 | $0.00 – $141.26 | 294,214 | 151 |
| Florence, AL | $52.05 | $0.00 – $421.68 | 293,928 | 192 |
| Gary, IN | $51.27 | $3.25 – $88.75 | 293,741 | 65 |
| Chino Hills, CA | $14.70 | $0.00 – $130.90 | 293,723 | 64 |
| Park Ridge, IL | $54.11 | $7.01 – $165.48 | 292,526 | 326 |
| Miamisburg, OH | $50.60 | $2.48 – $318.75 | 292,092 | 152 |
| Layton, UT | $54.85 | $0.00 – $177.14 | 291,501 | 164 |
| Westminster, MD | $78.02 | $0.00 – $181.53 | 291,380 | 173 |
| Killeen, TX | $42.66 | $0.00 – $122.76 | 291,117 | 159 |
| Winter Park, FL | $76.40 | $0.00 – $318.75 | 291,093 | 169 |
| Harrisonburg, VA | $55.84 | $0.00 – $96.77 | 290,915 | 189 |
| Cayey, PR | $24.55 | $0.00 – $159.39 | 290,420 | 110 |
| East Liverpool, OH | $53.33 | $0.00 – $123.75 | 289,908 | 64 |
| Easley, SC | $50.73 | $0.55 – $140.16 | 289,364 | 108 |
| Chambersburg, PA | $21.92 | $0.00 – $272.80 | 289,091 | 229 |
| Kew Gardens, NY | $67.65 | $11.91 – $128.53 | 288,326 | 37 |
| Bismarck, ND | $90.15 | $3.01 – $476.36 | 288,303 | 318 |
| Waianae, HI | $216.70 | $0.00 – $360.12 | 288,068 | 98 |
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.