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 |
|---|---|---|---|---|
| Chelsea, MA | $30.73 | $0.71 – $72.72 | 168,295 | 65 |
| San Juan, TX | $34.74 | $0.00 – $103.65 | 168,145 | 27 |
| North Platte, NE | $52.28 | $4.69 – $308.71 | 168,017 | 110 |
| Ocean, NJ | $77.41 | $0.92 – $131.69 | 167,998 | 59 |
| Williamsport, PA | $35.30 | $0.00 – $126.64 | 167,945 | 146 |
| Wayne, MI | $68.19 | $3.63 – $96.23 | 167,624 | 32 |
| Bennington, VT | $43.40 | $0.00 – $98.38 | 167,514 | 78 |
| Oak Grove, LA | $14.21 | $0.00 – $73.04 | 167,479 | 13 |
| Citrus Heights, CA | $8.63 | $0.00 – $631.97 | 167,469 | 49 |
| Normal, IL | $50.87 | $1.78 – $261.51 | 167,445 | 103 |
| Castro Valley, CA | $24.05 | $0.00 – $151.01 | 167,220 | 76 |
| Washington, IN | $55.43 | $28.49 – $116.24 | 167,200 | 57 |
| Davison, MI | $63.44 | $20.41 – $81.14 | 167,082 | 20 |
| Enterprise, AL | $50.68 | $0.00 – $221.85 | 166,994 | 71 |
| Cortland, NY | $70.69 | $23.59 – $155.21 | 166,827 | 75 |
| Burien, WA | $36.62 | $0.00 – $104.22 | 166,786 | 141 |
| Tazewell, TN | $34.73 | $14.00 – $81.22 | 166,749 | 24 |
| Pasadena, MD | $76.53 | $0.00 – $208.60 | 166,720 | 89 |
| Beverly, MA | $69.82 | $0.63 – $221.12 | 166,525 | 156 |
| Horseheads, NY | $80.73 | $12.65 – $136.57 | 166,477 | 65 |
| Sylva, NC | $72.58 | $0.00 – $683.61 | 166,368 | 108 |
| Northampton, MA | $45.84 | $1.55 – $219.36 | 166,226 | 136 |
| Pembroke, NC | $46.88 | $15.93 – $77.64 | 165,890 | 31 |
| Carrollton, TX | $32.24 | $0.00 – $129.26 | 165,632 | 64 |
| Coto Laurel, PR | $20.78 | $0.00 – $84.82 | 165,544 | 40 |
| Sun Valley, CA | $29.25 | $0.00 – $316.16 | 165,344 | 28 |
| Coal Grove, OH | $41.92 | $1.71 – $78.09 | 165,143 | 16 |
| South Miami, FL | $33.95 | $0.00 – $274.10 | 165,055 | 136 |
| Weston, FL | $56.67 | $0.00 – $138.04 | 165,028 | 138 |
| Kirksville, MO | $57.48 | $0.00 – $665.17 | 164,725 | 90 |
| Starkville, MS | $41.53 | $0.00 – $106.24 | 164,512 | 92 |
| Trujillo Alto, PR | $6.45 | $0.00 – $76.47 | 164,476 | 39 |
| Alexander City, AL | $47.36 | $0.54 – $217.90 | 164,351 | 52 |
| Hudson, FL | $60.08 | $0.00 – $145.48 | 164,165 | 71 |
| Millville, NJ | $33.12 | $0.00 – $83.15 | 164,095 | 34 |
| Fallbrook, CA | $20.63 | $0.00 – $120.94 | 164,088 | 24 |
| Lakeport, CA | $17.40 | $0.00 – $254.44 | 164,019 | 45 |
| East Setauket, NY | $87.84 | $0.00 – $214.47 | 163,824 | 180 |
| Oneida, NY | $77.82 | $10.55 – $621.89 | 163,749 | 80 |
| Morovis, PR | $4.69 | $0.00 – $47.83 | 163,658 | 27 |
| Williamson, WV | $24.67 | $0.00 – $81.38 | 163,323 | 35 |
| Ankeny, IA | $37.13 | $0.00 – $87.04 | 163,217 | 136 |
| Dillon, SC | $64.28 | $23.67 – $357.53 | 162,987 | 38 |
| Litchfield Park, AZ | $61.51 | $12.46 – $113.67 | 162,947 | 69 |
| Forest City, NC | $44.95 | $0.00 – $94.95 | 162,907 | 57 |
| Farmville, VA | $55.96 | $7.99 – $128.47 | 162,770 | 63 |
| Los Gatos, CA | $21.01 | $0.00 – $1,139 | 162,082 | 95 |
| Bozeman, MT | $87.35 | $0.00 – $373.12 | 161,915 | 271 |
| Dayton, TN | $37.30 | $0.23 – $545.37 | 161,778 | 40 |
| Harvey, LA | $31.97 | $0.00 – $85.79 | 161,754 | 45 |
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.