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 |
|---|---|---|---|---|
| Baldwin, NY | $71.00 | $6.19 – $169.82 | 240,624 | 22 |
| Exeter, CA | $11.23 | $0.00 – $624.52 | 240,552 | 21 |
| Potsdam, NY | $114.05 | $20.14 – $139.63 | 240,383 | 65 |
| Roanoke Rapids, NC | $46.55 | $0.00 – $373.58 | 240,136 | 89 |
| Round Rock, TX | $42.02 | $0.00 – $523.74 | 239,768 | 215 |
| Portsmouth, VA | $56.69 | $0.23 – $719.00 | 239,652 | 168 |
| Medina, OH | $53.99 | $0.00 – $199.22 | 238,962 | 146 |
| Palm Beach Gardens, FL | $51.53 | $0.00 – $196.25 | 238,935 | 96 |
| Duarte, CA | $29.40 | $0.00 – $918.36 | 238,905 | 183 |
| Wellington, FL | $58.40 | $0.00 – $166.06 | 238,801 | 109 |
| Booneville, KY | $29.96 | $11.00 – $40.37 | 238,684 | 16 |
| Allen Park, MI | $65.79 | $0.00 – $84.59 | 237,937 | 33 |
| Harbor City, CA | $13.37 | $0.00 – $214.17 | 237,879 | 216 |
| Jasper, AL | $52.22 | $0.00 – $229.20 | 237,759 | 86 |
| Orland Park, IL | $55.48 | $0.02 – $251.74 | 237,744 | 174 |
| La Porte, IN | $54.31 | $0.00 – $94.21 | 237,455 | 98 |
| Fajardo, PR | $5.92 | $0.00 – $96.33 | 237,185 | 69 |
| Sebring, FL | $35.53 | $0.00 – $89.09 | 237,135 | 113 |
| Glastonbury, CT | $48.62 | $0.00 – $105.35 | 237,105 | 144 |
| Baytown, TX | $40.38 | $0.00 – $117.81 | 236,930 | 117 |
| Mason, OH | $65.06 | $16.25 – $122.27 | 236,929 | 149 |
| Antioch, TN | $39.68 | $4.42 – $64.71 | 236,570 | 48 |
| Simpsonville, SC | $69.58 | $1.87 – $173.78 | 236,533 | 130 |
| Mountain View, CA | $22.04 | $0.00 – $840.67 | 236,087 | 170 |
| Belfast, ME | $18.13 | $2.31 – $841.89 | 235,992 | 40 |
| Frisco, TX | $45.81 | $0.00 – $198.03 | 235,519 | 162 |
| Springdale, AR | $41.90 | $0.00 – $318.75 | 235,507 | 158 |
| Montrose, CO | $75.58 | $0.00 – $329.55 | 235,506 | 154 |
| Lufkin, TX | $36.51 | $0.00 – $85.82 | 235,460 | 93 |
| Lees Summit, MO | $61.51 | $0.00 – $152.56 | 235,164 | 177 |
| Haverhill, MA | $48.44 | $0.00 – $123.54 | 235,138 | 97 |
| Richlands, VA | $52.73 | $6.38 – $99.53 | 235,027 | 59 |
| St George, UT | $67.48 | $0.00 – $274.65 | 234,617 | 246 |
| Clovis, NM | $76.74 | $0.69 – $155.59 | 234,587 | 78 |
| Salyersville, KY | $30.27 | $7.66 – $68.99 | 234,537 | 32 |
| Lexington, NC | $54.63 | $0.00 – $101.29 | 234,434 | 86 |
| Jennings, LA | $17.40 | $0.00 – $62.65 | 233,883 | 41 |
| Bloomfield, CT | $41.42 | $0.00 – $95.30 | 233,789 | 129 |
| Canoga Park, CA | $6.02 | $0.00 – $663.10 | 233,776 | 52 |
| Bourbonnais, IL | $52.24 | $11.48 – $153.07 | 233,724 | 83 |
| Rolla, MO | $65.47 | $0.73 – $674.88 | 233,555 | 143 |
| Kernersville, NC | $63.68 | $15.27 – $136.72 | 233,538 | 137 |
| San Tan Valley, AZ | $63.08 | $1.31 – $97.50 | 233,373 | 79 |
| Marysville, CA | $15.97 | $0.00 – $559.74 | 233,299 | 67 |
| Clinton, NC | $50.69 | $0.00 – $81.69 | 233,255 | 64 |
| Manchester, TN | $32.01 | $0.11 – $59.96 | 233,206 | 65 |
| Yukon, OK | $76.50 | $0.00 – $529.13 | 232,741 | 101 |
| Valley Stream, NY | $75.26 | $0.00 – $206.97 | 232,741 | 130 |
| Dunn, NC | $54.30 | $0.00 – $76.42 | 232,724 | 61 |
| North Chesterfield, VA | $65.49 | $0.00 – $186.65 | 232,565 | 185 |
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.