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 |
|---|---|---|---|---|
| Urbana, IL | $57.42 | $0.00 – $318.75 | 262,519 | 298 |
| Durango, CO | $86.23 | $0.00 – $615.05 | 262,459 | 216 |
| Hutchinson, KS | $73.70 | $0.00 – $579.14 | 262,406 | 132 |
| Springville, CA | $1.03 | $1.03 – $1.03 | 262,327 | 1 |
| Laguna Hills, CA | $46.97 | $0.00 – $1,082 | 261,023 | 137 |
| Attleboro, MA | $73.72 | $0.00 – $483.18 | 260,894 | 114 |
| Sierra Vista, AZ | $33.42 | $0.00 – $143.93 | 260,845 | 104 |
| Spring, TX | $44.12 | $0.00 – $179.95 | 260,561 | 116 |
| Mckinney, TX | $42.71 | $0.00 – $318.71 | 260,522 | 151 |
| Paragould, AR | $38.55 | $0.00 – $80.18 | 260,432 | 102 |
| Bremerton, WA | $41.84 | $0.00 – $542.54 | 260,431 | 156 |
| Rochester Hills, MI | $62.20 | $0.00 – $140.56 | 260,233 | 78 |
| Marquette, MI | $76.21 | $0.00 – $258.54 | 260,031 | 50 |
| San Pedro, CA | $24.54 | $0.00 – $630.50 | 259,871 | 63 |
| Petersburg, VA | $48.67 | $6.97 – $121.53 | 259,611 | 87 |
| Auburn, WA | $48.20 | $0.00 – $114.59 | 259,484 | 161 |
| Sunnyside, WA | $50.83 | $5.28 – $121.47 | 259,418 | 75 |
| Noblesville, IN | $63.26 | $0.00 – $318.46 | 259,371 | 167 |
| Waterford, MI | $61.75 | $0.85 – $82.99 | 259,110 | 46 |
| Grand Blanc, MI | $58.37 | $0.00 – $92.73 | 258,689 | 67 |
| Waukesha, WI | $31.79 | $0.00 – $213.40 | 258,119 | 230 |
| Compton, CA | $20.80 | $0.00 – $1,142 | 257,617 | 69 |
| Galion, OH | $54.97 | $0.00 – $99.31 | 257,282 | 58 |
| Uniontown, PA | $48.70 | $0.00 – $92.49 | 256,978 | 122 |
| Mt Sterling, KY | $35.71 | $6.31 – $87.15 | 256,590 | 63 |
| Willoughby, OH | $54.97 | $6.31 – $345.00 | 256,444 | 134 |
| Smithtown, NY | $102.70 | $0.00 – $187.93 | 256,273 | 183 |
| Holland, MI | $62.09 | $0.00 – $386.40 | 256,005 | 54 |
| Ripley, MS | $50.05 | $4.61 – $97.70 | 256,002 | 27 |
| Miami Lakes, FL | $39.14 | $0.00 – $275.76 | 255,989 | 99 |
| Juana Diaz, PR | $4.96 | $0.00 – $109.54 | 255,339 | 52 |
| Lillington, NC | $51.35 | $2.33 – $83.76 | 255,320 | 55 |
| Paintsville, KY | $34.84 | $4.63 – $96.37 | 255,105 | 45 |
| Fishers, IN | $60.65 | $0.00 – $132.83 | 254,978 | 226 |
| Freehold, NJ | $62.87 | $0.00 – $198.68 | 254,912 | 146 |
| Pahrump, NV | $45.24 | $0.00 – $173.56 | 254,767 | 75 |
| Lenoir, NC | $45.19 | $5.56 – $121.69 | 254,696 | 112 |
| Teaneck, NJ | $50.18 | $1.92 – $166.08 | 254,672 | 140 |
| Patchogue, NY | $68.01 | $0.00 – $169.41 | 254,368 | 100 |
| Pearland, TX | $51.45 | $0.00 – $421.88 | 254,247 | 142 |
| Wichita Falls, TX | $47.34 | $0.00 – $736.72 | 254,096 | 201 |
| Mountain Home, AR | $37.35 | $0.45 – $169.97 | 253,925 | 128 |
| Laurinburg, NC | $51.61 | $3.67 – $87.06 | 253,672 | 86 |
| Garden City, NY | $79.19 | $0.00 – $303.71 | 252,781 | 185 |
| Ridgewood, NY | $36.48 | $0.00 – $121.19 | 252,574 | 44 |
| Duluth, MN | $68.97 | $0.00 – $621.30 | 252,568 | 482 |
| Mason City, IA | $32.52 | $0.00 – $313.15 | 251,985 | 192 |
| Oshkosh, WI | $34.26 | $0.69 – $271.75 | 251,844 | 226 |
| Palm Springs, FL | $60.06 | $0.00 – $318.75 | 251,679 | 54 |
| Wooster, OH | $52.06 | $0.00 – $120.54 | 251,324 | 167 |
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.