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 |
|---|---|---|---|---|
| Lakewood, OH | $36.68 | $3.29 – $81.08 | 218,994 | 98 |
| Casper, WY | $42.58 | $0.00 – $164.56 | 218,862 | 233 |
| Shelbyville, IN | $61.18 | $20.69 – $106.66 | 218,831 | 99 |
| Rogers, AR | $41.87 | $0.00 – $601.51 | 218,757 | 184 |
| North Haven, CT | $57.71 | $0.00 – $141.59 | 218,735 | 131 |
| Littleton, CO | $75.51 | $0.00 – $455.49 | 218,503 | 271 |
| Commerce, CA | $14.72 | $0.00 – $1,154 | 218,369 | 37 |
| Adrian, MI | $85.57 | $1.64 – $265.03 | 218,347 | 30 |
| Culpeper, VA | $79.58 | $1.57 – $267.16 | 217,881 | 112 |
| Lindsay, CA | $10.51 | $0.00 – $141.80 | 217,324 | 25 |
| South Ozone Park, NY | $81.75 | $4.58 – $117.11 | 216,861 | 21 |
| Clinton, MD | $73.88 | $0.00 – $215.81 | 216,742 | 120 |
| Rio Grande City, TX | $27.22 | $0.00 – $41.31 | 216,639 | 33 |
| Cinnaminson, NJ | $90.16 | $20.00 – $125.77 | 216,629 | 21 |
| Cerritos, CA | $52.75 | $0.00 – $1,223 | 216,551 | 97 |
| North Wilkesboro, NC | $57.71 | $10.24 – $84.24 | 216,544 | 70 |
| Red Bank, NJ | $45.66 | $0.00 – $112.90 | 216,539 | 61 |
| Leitchfield, KY | $37.36 | $18.34 – $65.35 | 216,378 | 66 |
| Canon City, CO | $96.43 | $0.00 – $519.00 | 216,288 | 78 |
| Albany, OR | $69.29 | $0.00 – $203.63 | 215,992 | 150 |
| Bloomingdale, IL | $40.66 | $0.00 – $150.32 | 215,706 | 67 |
| Shelbyville, KY | $40.59 | $14.38 – $79.31 | 215,699 | 71 |
| Elizabethton, TN | $38.02 | $6.03 – $75.25 | 215,629 | 80 |
| Tolleson, AZ | $72.55 | $19.38 – $96.81 | 215,548 | 14 |
| Orange Park, FL | $40.46 | $0.00 – $141.86 | 215,468 | 133 |
| Grand Island, NE | $60.90 | $0.00 – $334.66 | 215,326 | 180 |
| Huntersville, NC | $56.31 | $0.00 – $132.18 | 215,187 | 230 |
| Ames, IA | $34.86 | $0.00 – $95.87 | 215,057 | 179 |
| Arvin, CA | $37.90 | $15.17 – $72.04 | 214,473 | 22 |
| Somerset, NJ | $56.75 | $0.00 – $186.67 | 214,420 | 102 |
| Bound Brook, NJ | $98.50 | $14.21 – $108.68 | 213,877 | 15 |
| Ontario, OH | $53.20 | $0.63 – $119.43 | 213,794 | 66 |
| Cabo Rojo, PR | $3.79 | $0.00 – $123.84 | 213,588 | 47 |
| Americus, GA | $91.09 | $11.74 – $216.44 | 213,411 | 34 |
| Logan, OH | $45.37 | $0.22 – $125.86 | 213,085 | 56 |
| Valhalla, NY | $112.66 | $0.00 – $293.44 | 212,962 | 143 |
| Cuyahoga Falls, OH | $42.38 | $2.65 – $331.42 | 212,462 | 131 |
| Okemos, MI | $49.04 | $0.00 – $99.85 | 212,377 | 42 |
| Douglas, AZ | $13.49 | $0.00 – $555.26 | 212,339 | 28 |
| Gridley, CA | $19.01 | $0.00 – $854.62 | 212,321 | 14 |
| Chicopee, MA | $46.01 | $1.88 – $73.09 | 212,265 | 72 |
| Pine Bluff, AR | $37.68 | $0.00 – $98.13 | 212,021 | 129 |
| Southington, CT | $45.43 | $0.00 – $102.13 | 211,805 | 90 |
| West Plains, MO | $53.49 | $1.08 – $640.00 | 211,745 | 112 |
| Woodland Hills, CA | $30.01 | $0.00 – $1,060 | 211,413 | 226 |
| Antioch, CA | $42.14 | $0.00 – $1,061 | 211,057 | 165 |
| Sherman, TX | $55.89 | $0.00 – $612.35 | 211,049 | 99 |
| Olean, NY | $65.33 | $0.00 – $185.33 | 210,345 | 123 |
| Saratoga Springs, NY | $82.86 | $3.32 – $521.37 | 209,991 | 214 |
| Farmington, MO | $52.89 | $0.00 – $178.12 | 209,915 | 117 |
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.