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 |
|---|---|---|---|---|
| Defiance, OH | $43.24 | $0.00 – $121.11 | 174,639 | 79 |
| Vienna, VA | $38.88 | $0.00 – $119.82 | 174,255 | 101 |
| Pleasantville, NJ | $31.02 | $0.03 – $87.48 | 174,018 | 34 |
| Woburn, MA | $66.84 | $1.78 – $235.73 | 173,969 | 73 |
| Ormond Beach, FL | $47.75 | $0.00 – $103.68 | 173,960 | 73 |
| Lenoir City, TN | $39.03 | $0.00 – $66.71 | 173,958 | 88 |
| Raeford, NC | $53.94 | $0.00 – $360.48 | 173,586 | 58 |
| Baker, LA | $41.82 | $0.00 – $75.20 | 173,314 | 27 |
| Parker, CO | $75.53 | $0.00 – $210.51 | 173,300 | 191 |
| Lafayette, CO | $94.91 | $0.00 – $365.73 | 173,294 | 157 |
| Mcalester, OK | $206.04 | $0.00 – $719.00 | 173,227 | 106 |
| Denton, TX | $48.29 | $0.00 – $662.52 | 172,941 | 136 |
| Oxon Hill, MD | $83.91 | $0.00 – $245.78 | 172,742 | 63 |
| Danvers, MA | $47.98 | $0.00 – $115.90 | 172,505 | 149 |
| Bartlett, TN | $33.72 | $0.00 – $59.23 | 172,439 | 84 |
| Brandon, MS | $53.02 | $0.00 – $288.37 | 172,392 | 68 |
| Poway, CA | $45.20 | $0.00 – $131.14 | 172,325 | 71 |
| Port Arthur, TX | $34.02 | $0.00 – $129.37 | 172,067 | 44 |
| Canton, MI | $64.46 | $0.24 – $138.07 | 171,828 | 55 |
| Franklin, KY | $37.12 | $0.00 – $50.04 | 171,455 | 45 |
| La Palma, CA | $44.77 | $0.00 – $172.94 | 171,442 | 46 |
| Northfield, NJ | $54.45 | $0.40 – $98.42 | 171,344 | 52 |
| Jericho, NY | $120.13 | $0.00 – $133.56 | 171,174 | 24 |
| Barstow, CA | $33.31 | $0.00 – $902.99 | 171,037 | 35 |
| Clio, MI | $56.10 | $12.23 – $82.56 | 170,844 | 7 |
| Guntersville, AL | $34.81 | $0.00 – $196.59 | 170,744 | 69 |
| Springfield, VA | $71.54 | $5.93 – $164.22 | 170,721 | 118 |
| Old Bridge, NJ | $56.43 | $0.00 – $159.56 | 170,500 | 70 |
| Summersville, WV | $19.99 | $0.00 – $85.42 | 170,499 | 62 |
| Wesley Chapel, FL | $47.68 | $0.00 – $691.84 | 170,435 | 127 |
| Fort Bragg, CA | $19.14 | $0.00 – $372.45 | 170,421 | 38 |
| Florissant, MO | $55.80 | $4.81 – $318.75 | 170,343 | 106 |
| Moca, PR | $8.93 | $0.00 – $66.98 | 170,290 | 48 |
| Latham, NY | $74.76 | $1.97 – $153.72 | 170,004 | 168 |
| Butte, MT | $45.45 | $0.00 – $169.46 | 169,808 | 81 |
| West Liberty, KY | $31.93 | $10.01 – $44.29 | 169,766 | 24 |
| Elkins, WV | $30.90 | $0.00 – $94.94 | 169,670 | 107 |
| New Berlin, WI | $46.05 | $8.38 – $77.75 | 169,515 | 155 |
| Cheyenne, WY | $50.89 | $0.00 – $186.70 | 169,133 | 208 |
| Centralia, WA | $58.50 | $0.00 – $418.38 | 169,081 | 87 |
| West Coxsackie, NY | $65.35 | $56.80 – $111.92 | 169,017 | 21 |
| Hannibal, MO | $50.10 | $0.00 – $130.28 | 168,984 | 131 |
| Corning, NY | $82.01 | $9.72 – $126.52 | 168,969 | 77 |
| Beloit, WI | $32.54 | $2.40 – $90.93 | 168,794 | 105 |
| Berlin, VT | $34.72 | $0.00 – $98.85 | 168,640 | 108 |
| Nottingham, MD | $107.24 | $0.00 – $229.75 | 168,546 | 93 |
| Grand Prairie, TX | $44.97 | $0.65 – $318.75 | 168,496 | 71 |
| Madison, AL | $59.62 | $0.00 – $967.65 | 168,475 | 105 |
| Vestal, NY | $65.57 | $13.59 – $218.72 | 168,475 | 132 |
| Harrison, AR | $36.44 | $2.36 – $114.79 | 168,323 | 83 |
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.