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 |
|---|---|---|---|---|
| Munfordville, KY | $38.81 | $16.32 – $52.84 | 151,520 | 23 |
| Houlton, ME | $12.54 | $2.78 – $82.75 | 150,990 | 16 |
| Marysville, OH | $51.09 | $0.00 – $92.12 | 150,967 | 102 |
| Christiansburg, VA | $57.05 | $1.23 – $167.54 | 150,913 | 135 |
| Trinity, FL | $48.75 | $0.00 – $89.18 | 150,577 | 56 |
| Independence, LA | $32.31 | $0.00 – $49.97 | 150,417 | 23 |
| Kensington, MD | $87.55 | $0.23 – $221.85 | 150,409 | 72 |
| Kailua, HI | $49.94 | $0.00 – $634.55 | 150,243 | 98 |
| Lacey, WA | $49.13 | $0.07 – $133.47 | 150,148 | 116 |
| Buckeye, AZ | $56.75 | $0.00 – $636.73 | 150,080 | 48 |
| Sheffield Village, OH | $52.64 | $17.29 – $103.25 | 150,058 | 64 |
| Glen Cove, NY | $82.28 | $0.00 – $203.84 | 149,715 | 72 |
| Greenville, OH | $32.40 | $0.00 – $137.32 | 149,181 | 65 |
| Paris, KY | $50.85 | $5.09 – $105.56 | 149,165 | 30 |
| Rome, GA | $51.19 | $0.00 – $132.91 | 149,147 | 94 |
| Fayetteville, TN | $41.55 | $10.90 – $70.58 | 148,588 | 40 |
| Washington Court House, OH | $41.58 | $0.12 – $156.11 | 148,562 | 44 |
| Harrisburg, IL | $5.14 | $0.00 – $75.29 | 148,399 | 23 |
| Yorba Linda, CA | $56.97 | $0.00 – $147.32 | 148,127 | 74 |
| Scott Depot, WV | $24.01 | $0.00 – $76.04 | 148,119 | 45 |
| Brookfield, CT | $63.70 | $0.00 – $117.00 | 147,932 | 55 |
| Largo, MD | $88.53 | $0.00 – $212.37 | 147,678 | 95 |
| Oakland, MD | $101.03 | $1.31 – $321.01 | 147,503 | 75 |
| Sedalia, MO | $57.57 | $0.00 – $415.46 | 147,434 | 79 |
| Geneva, NY | $65.11 | $0.00 – $131.44 | 147,427 | 97 |
| Gallup, NM | $94.87 | $0.00 – $599.10 | 147,355 | 95 |
| Mankato, MN | $81.44 | $10.78 – $590.73 | 147,155 | 229 |
| Washington, NC | $57.01 | $10.03 – $87.28 | 146,942 | 64 |
| Canandaigua, NY | $84.09 | $18.32 – $182.47 | 146,802 | 104 |
| Gurabo, PR | $6.62 | $0.00 – $84.74 | 146,688 | 48 |
| Sunrise, FL | $59.62 | $0.00 – $141.85 | 146,656 | 57 |
| Palos Heights, IL | $72.88 | $0.00 – $631.34 | 146,421 | 87 |
| Pottsville, PA | $40.51 | $0.00 – $136.29 | 146,350 | 71 |
| Valdosta, GA | $46.69 | $0.00 – $151.88 | 146,202 | 76 |
| Benton, AR | $36.53 | $1.93 – $77.29 | 145,922 | 67 |
| Grenada, MS | $55.54 | $0.00 – $149.52 | 145,893 | 65 |
| Edina, MN | $69.12 | $0.00 – $427.94 | 145,843 | 313 |
| Peru, IN | $53.36 | $29.57 – $110.93 | 145,834 | 40 |
| Saint Helena, CA | $24.49 | $0.00 – $521.76 | 145,797 | 36 |
| Dover, NJ | $33.12 | $0.00 – $58.39 | 145,578 | 36 |
| Oxford, NC | $44.08 | $0.00 – $106.40 | 145,476 | 65 |
| Russellville, KY | $35.60 | $19.20 – $51.22 | 145,270 | 38 |
| Mc Kenzie, TN | $35.96 | $13.04 – $69.25 | 145,215 | 34 |
| Crystal Lake, IL | $61.60 | $5.12 – $375.52 | 145,211 | 127 |
| East Providence, RI | $66.28 | $0.00 – $308.45 | 145,181 | 159 |
| Orchard Park, NY | $59.66 | $2.78 – $155.41 | 145,146 | 206 |
| Westfield, MA | $51.17 | $3.27 – $100.73 | 145,101 | 72 |
| Lawrence, KS | $104.79 | $0.00 – $481.00 | 144,980 | 176 |
| Sterling, IL | $49.16 | $7.85 – $102.86 | 144,887 | 75 |
| Jamaica Estates, NY | $67.08 | $26.14 – $70.19 | 144,760 | 5 |
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.