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 |
|---|---|---|---|---|
| Ithaca, NY | $91.74 | $0.00 – $485.74 | 275,900 | 201 |
| Kent, WA | $38.44 | $0.00 – $128.18 | 275,742 | 152 |
| Clearlake, CA | $18.30 | $0.00 – $879.62 | 275,577 | 33 |
| Coachella, CA | $6.48 | $0.00 – $1,060 | 275,326 | 28 |
| Muskogee, OK | $77.61 | $0.00 – $568.84 | 275,113 | 132 |
| Hixson, TN | $27.88 | $0.00 – $185.89 | 274,539 | 97 |
| Matthews, NC | $68.86 | $0.00 – $176.95 | 274,323 | 172 |
| Annandale, VA | $36.02 | $0.00 – $188.97 | 274,127 | 100 |
| Albemarle, NC | $59.41 | $0.00 – $85.04 | 273,423 | 81 |
| Vincennes, IN | $54.11 | $4.39 – $131.75 | 272,932 | 114 |
| Denham Springs, LA | $44.36 | $0.00 – $169.91 | 272,487 | 64 |
| Coral Springs, FL | $55.24 | $0.00 – $441.78 | 272,312 | 175 |
| Brentwood, TN | $37.21 | $0.00 – $338.27 | 272,272 | 158 |
| Fort Payne, AL | $16.20 | $0.00 – $74.27 | 271,829 | 78 |
| Albany, GA | $44.66 | $0.00 – $111.59 | 271,573 | 150 |
| Pascagoula, MS | $49.46 | $0.00 – $73.52 | 271,483 | 106 |
| Edgewood, KY | $37.98 | $2.57 – $113.97 | 271,432 | 214 |
| Columbia, KY | $31.56 | $0.00 – $90.41 | 270,921 | 53 |
| Port St Lucie, FL | $56.18 | $0.00 – $283.45 | 270,629 | 147 |
| Alcoa, TN | $38.44 | $0.00 – $79.50 | 270,375 | 136 |
| Portage, IN | $53.63 | $6.99 – $82.17 | 270,325 | 70 |
| Owings Mills, MD | $67.25 | $0.00 – $231.07 | 270,159 | 146 |
| Port Charlotte, FL | $63.40 | $0.00 – $157.05 | 269,846 | 146 |
| Richmond, TX | $50.57 | $0.00 – $639.03 | 269,510 | 96 |
| Mount Clemens, MI | $53.67 | $0.00 – $71.50 | 268,977 | 20 |
| Wailuku, HI | $101.65 | $0.00 – $344.37 | 268,889 | 184 |
| Columbus, GA | $44.45 | $0.00 – $186.62 | 268,528 | 193 |
| Morehead City, NC | $56.61 | $5.16 – $96.12 | 268,481 | 138 |
| Coos Bay, OR | $37.44 | $0.00 – $370.47 | 268,436 | 144 |
| Union City, TN | $35.99 | $0.00 – $54.65 | 268,213 | 71 |
| Riverhead, NY | $70.92 | $0.00 – $182.25 | 267,624 | 129 |
| Linden, NJ | $68.82 | $7.85 – $178.87 | 266,930 | 47 |
| Alton, IL | $31.44 | $0.00 – $576.22 | 266,790 | 111 |
| Spring Hill, FL | $60.60 | $0.00 – $572.76 | 266,719 | 94 |
| Bettendorf, IA | $41.73 | $0.00 – $89.43 | 266,715 | 152 |
| Festus, MO | $54.91 | $0.00 – $121.71 | 266,714 | 127 |
| Grass Valley, CA | $22.03 | $0.00 – $1,145 | 266,669 | 112 |
| Oswego, NY | $100.99 | $0.00 – $184.57 | 266,215 | 94 |
| Johnston, RI | $61.49 | $0.00 – $125.83 | 265,940 | 94 |
| Kerman, CA | $3.92 | $0.00 – $747.54 | 265,282 | 17 |
| Perris, CA | $14.90 | $0.00 – $1,711 | 264,809 | 39 |
| Lompoc, CA | $32.23 | $0.00 – $857.35 | 264,617 | 85 |
| Saint Joseph, MI | $60.20 | $0.00 – $221.08 | 264,608 | 55 |
| Auburn, NY | $89.68 | $0.00 – $215.24 | 264,565 | 144 |
| Stratford, CT | $47.81 | $0.00 – $121.32 | 264,528 | 90 |
| Rockingham, NC | $55.93 | $0.00 – $100.50 | 263,652 | 54 |
| Centerville, OH | $47.93 | $0.00 – $122.66 | 263,176 | 198 |
| Dickson, TN | $36.09 | $0.00 – $82.83 | 263,147 | 110 |
| Stockbridge, GA | $70.65 | $0.00 – $153.61 | 262,972 | 99 |
| Santa Paula, CA | $18.90 | $0.00 – $446.21 | 262,714 | 39 |
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.