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 |
|---|---|---|---|---|
| Mount Pleasant, WI | $34.63 | $10.35 – $88.70 | 182,605 | 121 |
| Herrin, IL | $14.61 | $0.00 – $83.40 | 182,238 | 60 |
| Grundy, VA | $42.30 | $14.94 – $81.21 | 182,174 | 33 |
| Salina, KS | $57.45 | $0.00 – $278.48 | 182,086 | 139 |
| Rocky Hill, CT | $51.08 | $0.00 – $88.25 | 182,071 | 68 |
| Lake Havasu City, AZ | $53.06 | $0.00 – $140.05 | 181,966 | 106 |
| Hammonton, NJ | $39.20 | $0.00 – $166.87 | 181,648 | 65 |
| Silverdale, WA | $58.46 | $2.08 – $143.53 | 181,601 | 191 |
| Safford, AZ | $28.04 | $0.00 – $106.91 | 181,545 | 57 |
| Cleveland, TX | $37.80 | $0.00 – $54.91 | 181,494 | 25 |
| Portsmouth, NH | $43.24 | $0.00 – $250.00 | 181,205 | 134 |
| Portales, NM | $76.18 | $0.00 – $148.29 | 180,958 | 27 |
| Harris, NY | $25.07 | $7.40 – $158.46 | 180,956 | 21 |
| Largo, FL | $39.45 | $0.00 – $136.85 | 180,877 | 149 |
| Saint Cloud, FL | $45.16 | $0.00 – $242.86 | 180,828 | 81 |
| Enid, OK | $72.02 | $0.00 – $162.24 | 180,784 | 119 |
| Bell, CA | $6.49 | $0.00 – $86.03 | 180,594 | 33 |
| Whiteriver, AZ | $505.46 | $0.00 – $517.51 | 179,906 | 9 |
| Shepherdsville, KY | $42.23 | $9.98 – $99.39 | 179,746 | 55 |
| Doral, FL | $37.02 | $0.00 – $308.12 | 179,632 | 105 |
| Cynthiana, KY | $43.54 | $6.99 – $66.37 | 179,356 | 51 |
| Lovington, NM | $105.92 | $6.78 – $236.32 | 179,294 | 52 |
| Shallotte, NC | $60.70 | $1.74 – $121.49 | 179,213 | 61 |
| Cottonwood, AZ | $55.45 | $0.00 – $704.56 | 178,921 | 105 |
| East Stroudsburg, PA | $51.74 | $3.05 – $150.61 | 178,807 | 86 |
| Jamestown, TN | $42.44 | $10.58 – $77.30 | 178,662 | 27 |
| Pinellas Park, FL | $43.17 | $0.00 – $139.65 | 178,574 | 59 |
| Foley, AL | $58.72 | $0.00 – $207.76 | 178,574 | 64 |
| Troy, AL | $47.79 | $0.00 – $211.02 | 178,530 | 56 |
| Woodbury, MN | $71.37 | $4.67 – $773.11 | 178,169 | 339 |
| Kingwood, TX | $54.21 | $0.00 – $155.30 | 178,145 | 124 |
| Briarwood, NY | $72.03 | $3.07 – $215.41 | 177,691 | 16 |
| Derby, CT | $48.01 | $0.00 – $102.32 | 177,636 | 87 |
| Monticello, NY | $75.53 | $4.13 – $186.40 | 177,536 | 43 |
| Corydon, IN | $50.11 | $9.49 – $81.80 | 177,303 | 61 |
| Vernon, CT | $52.52 | $0.00 – $465.97 | 177,215 | 87 |
| Reynoldsburg, OH | $56.45 | $4.78 – $127.87 | 177,044 | 70 |
| Woodmere, NY | $61.24 | $1.78 – $133.20 | 176,692 | 36 |
| Westbury, NY | $62.30 | $0.00 – $140.07 | 176,407 | 47 |
| Willowbrook, IL | $56.97 | $15.49 – $90.74 | 176,233 | 80 |
| Wasco, CA | $30.39 | $0.00 – $541.59 | 176,212 | 23 |
| Circleville, OH | $45.42 | $0.00 – $719.00 | 176,112 | 83 |
| Dyer, IN | $59.64 | $0.00 – $94.12 | 175,783 | 76 |
| Lawrenceburg, IN | $55.37 | $20.75 – $104.33 | 175,636 | 80 |
| Perrysburg, OH | $51.61 | $15.37 – $139.31 | 175,563 | 139 |
| Powell, TN | $39.83 | $3.95 – $89.72 | 175,407 | 102 |
| Yreka, CA | $14.50 | $0.00 – $255.24 | 175,381 | 54 |
| New Braunfels, TX | $38.79 | $0.00 – $102.95 | 175,177 | 117 |
| Warner Robins, GA | $56.26 | $0.00 – $669.19 | 175,165 | 77 |
| Olympia Fields, IL | $32.50 | $0.00 – $302.04 | 174,869 | 93 |
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.