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 |
|---|---|---|---|---|
| La Follette, TN | $37.93 | $10.96 – $67.16 | 156,936 | 37 |
| Orland, CA | $16.11 | $0.00 – $597.99 | 156,897 | 15 |
| Highland, IN | $62.03 | $4.27 – $243.10 | 156,892 | 57 |
| Nacogdoches, TX | $34.78 | $0.60 – $111.02 | 156,837 | 74 |
| Maumee, OH | $57.29 | $9.21 – $345.00 | 156,810 | 131 |
| Vanceburg, KY | $33.43 | $7.70 – $54.84 | 156,743 | 35 |
| Port Saint Lucie, FL | $51.29 | $0.00 – $131.95 | 156,742 | 59 |
| Canovanas, PR | $3.83 | $0.00 – $92.82 | 156,647 | 47 |
| Bolivar, MO | $84.30 | $11.29 – $164.01 | 156,596 | 87 |
| Fishkill, NY | $95.89 | $21.26 – $294.66 | 156,586 | 109 |
| Coldwater, MI | $43.07 | $1.70 – $698.81 | 156,414 | 28 |
| Bensalem, PA | $41.47 | $0.00 – $99.82 | 156,410 | 77 |
| Brighton, MI | $60.25 | $0.00 – $102.38 | 156,383 | 53 |
| North Easton, MA | $43.90 | $4.67 – $77.15 | 156,216 | 66 |
| Brewer, ME | $17.57 | $0.00 – $143.84 | 156,024 | 60 |
| Russell Springs, KY | $29.42 | $12.36 – $62.90 | 155,992 | 33 |
| N Las Vegas, NV | $55.21 | $0.01 – $139.29 | 155,937 | 42 |
| Harriman, TN | $30.82 | $0.00 – $115.08 | 155,857 | 43 |
| Pulaski, TN | $35.20 | $7.05 – $87.30 | 155,670 | 32 |
| Bryan, OH | $43.55 | $1.27 – $167.51 | 155,486 | 75 |
| Stevens Point, WI | $40.10 | $1.16 – $148.35 | 155,372 | 124 |
| Logan, UT | $68.22 | $0.00 – $194.39 | 155,216 | 131 |
| Colusa, CA | $12.40 | $0.00 – $822.26 | 155,195 | 20 |
| Orange Cove, CA | $1.99 | $0.00 – $11.79 | 155,193 | 10 |
| Soledad, CA | $22.60 | $0.00 – $721.70 | 155,139 | 9 |
| Cambridge, MD | $95.56 | $0.00 – $186.81 | 154,530 | 55 |
| Millington, TN | $35.79 | $0.00 – $187.34 | 154,521 | 31 |
| Brunswick, ME | $40.93 | $1.94 – $184.62 | 154,510 | 187 |
| Santurce, PR | $24.67 | $0.00 – $134.84 | 154,499 | 61 |
| Evans, CO | $152.92 | $17.56 – $677.22 | 154,350 | 45 |
| Gurnee, IL | $54.29 | $2.79 – $147.12 | 154,245 | 110 |
| Dunkirk, NY | $63.57 | $14.40 – $140.50 | 154,201 | 58 |
| Hawthorne, NY | $133.96 | $0.00 – $235.32 | 153,681 | 147 |
| Mount Vernon, KY | $36.99 | $14.73 – $61.49 | 153,628 | 35 |
| Sikeston, MO | $69.78 | $0.00 – $184.33 | 153,515 | 101 |
| Bartlesville, OK | $71.77 | $2.14 – $117.93 | 153,248 | 100 |
| Alma, MI | $48.32 | $17.22 – $85.25 | 153,234 | 29 |
| Salem, IL | $16.94 | $0.00 – $118.19 | 153,073 | 22 |
| League City, TX | $61.35 | $1.43 – $694.03 | 153,047 | 100 |
| Chicago Heights, IL | $5.21 | $0.02 – $66.73 | 152,977 | 24 |
| Lucedale, MS | $67.89 | $4.36 – $174.98 | 152,590 | 39 |
| Evergreen Park, IL | $56.59 | $2.11 – $271.82 | 152,462 | 77 |
| Kearney, NE | $56.11 | $0.00 – $331.26 | 152,363 | 154 |
| Athens, AL | $36.58 | $0.00 – $208.47 | 152,131 | 98 |
| Holmdel, NJ | $37.86 | $0.00 – $135.07 | 152,100 | 43 |
| Revere, MA | $39.07 | $0.10 – $89.83 | 151,829 | 65 |
| Matawan, NJ | $51.69 | $0.00 – $102.77 | 151,816 | 18 |
| New Castle, PA | $40.41 | $0.00 – $89.11 | 151,696 | 80 |
| Orangeburg, NY | $214.83 | $4.58 – $284.46 | 151,621 | 32 |
| Maplewood, NJ | $42.00 | $0.32 – $127.50 | 151,566 | 41 |
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.