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 |
|---|---|---|---|---|
| Hyannis, MA | $53.14 | $0.00 – $177.68 | 251,266 | 226 |
| Putnam, CT | $44.74 | $0.00 – $109.09 | 251,187 | 83 |
| Austintown, OH | $63.14 | $2.07 – $141.36 | 251,153 | 64 |
| Hermitage, TN | $39.12 | $5.73 – $829.31 | 250,984 | 135 |
| Winter Haven, FL | $54.07 | $0.00 – $116.79 | 250,254 | 167 |
| Apopka, FL | $47.84 | $0.63 – $738.94 | 249,920 | 96 |
| San Mateo, CA | $50.22 | $0.00 – $1,537 | 249,879 | 177 |
| Portage, MI | $67.27 | $6.79 – $286.85 | 249,805 | 33 |
| Commack, NY | $85.61 | $0.00 – $172.01 | 249,730 | 81 |
| Carlsbad, NM | $83.99 | $27.10 – $194.42 | 249,698 | 82 |
| New Albany, MS | $49.16 | $7.45 – $135.23 | 249,675 | 96 |
| Brentwood, NY | $59.90 | $12.08 – $162.40 | 249,153 | 48 |
| Bloomfield, NJ | $42.46 | $0.00 – $223.07 | 249,044 | 76 |
| Wilmington, OH | $43.62 | $0.40 – $112.28 | 249,036 | 86 |
| Mt Pleasant, MI | $125.04 | $0.00 – $297.64 | 248,964 | 36 |
| Waverly, OH | $38.68 | $0.28 – $122.14 | 248,728 | 42 |
| Bethel, AK | $198.41 | $0.00 – $779.26 | 248,650 | 102 |
| Henderson, NC | $50.11 | $0.00 – $97.17 | 248,397 | 78 |
| Winslow, AZ | $498.15 | $0.00 – $548.68 | 248,023 | 36 |
| West Burlington, IA | $23.20 | $0.00 – $63.22 | 247,532 | 105 |
| Stafford, VA | $64.33 | $0.00 – $103.65 | 247,379 | 73 |
| Elizabeth City, NC | $44.41 | $0.00 – $128.98 | 247,048 | 128 |
| Arcadia, CA | $37.54 | $0.00 – $810.61 | 246,763 | 189 |
| Clarksdale, MS | $59.91 | $0.00 – $171.52 | 245,509 | 71 |
| Bowie, MD | $77.40 | $0.47 – $226.08 | 245,498 | 155 |
| Freeport, NY | $49.51 | $0.00 – $236.72 | 245,410 | 66 |
| Granite City, IL | $23.16 | $0.00 – $166.66 | 244,898 | 48 |
| Broken Arrow, OK | $82.06 | $0.00 – $400.08 | 244,745 | 114 |
| Lincolnton, NC | $55.97 | $9.23 – $88.10 | 244,731 | 95 |
| Sanford, NC | $56.54 | $0.12 – $188.30 | 244,625 | 165 |
| Palm Desert, CA | $53.76 | $0.00 – $397.00 | 244,605 | 85 |
| Boulder, CO | $96.83 | $0.00 – $679.96 | 244,107 | 277 |
| Westlake, OH | $42.38 | $0.63 – $119.69 | 243,754 | 244 |
| Placerville, CA | $44.24 | $0.00 – $410.61 | 243,674 | 93 |
| Hammond, IN | $53.84 | $0.46 – $81.91 | 243,570 | 69 |
| Hatillo, PR | $6.54 | $0.00 – $86.63 | 243,488 | 61 |
| Baldwin Park, CA | $21.20 | $0.00 – $232.57 | 243,335 | 279 |
| Klamath Falls, OR | $30.97 | $0.00 – $424.13 | 243,168 | 184 |
| Crescent City, CA | $17.68 | $0.00 – $1,102 | 243,127 | 46 |
| Zachary, LA | $30.11 | $0.00 – $83.77 | 242,975 | 78 |
| Wausau, WI | $35.51 | $0.00 – $138.35 | 242,386 | 283 |
| Gainesville, GA | $64.98 | $0.00 – $489.62 | 242,258 | 128 |
| Decatur, GA | $54.75 | $0.00 – $640.00 | 241,656 | 157 |
| Camarillo, CA | $29.09 | $0.00 – $646.52 | 241,578 | 99 |
| Hyattsville, MD | $78.44 | $0.00 – $176.85 | 241,445 | 106 |
| Lewiston, ID | $56.09 | $0.78 – $112.69 | 241,299 | 147 |
| Jefferson City, MO | $59.27 | $3.23 – $210.75 | 241,146 | 210 |
| Avon, IN | $60.50 | $0.00 – $121.58 | 241,128 | 188 |
| Cape May Court House, NJ | $66.51 | $0.00 – $116.35 | 241,016 | 89 |
| New Castle, IN | $50.36 | $0.00 – $94.64 | 240,852 | 92 |
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.