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 |
|---|---|---|---|---|
| O Fallon, IL | $32.51 | $0.00 – $91.69 | 144,742 | 77 |
| Lindenhurst, NY | $59.64 | $0.17 – $135.85 | 144,700 | 39 |
| Malone, NY | $92.08 | $0.00 – $417.37 | 144,410 | 49 |
| Orange City, FL | $47.42 | $0.00 – $153.73 | 144,291 | 123 |
| Kingwood, WV | $47.14 | $16.25 – $75.67 | 144,281 | 31 |
| Hornell, NY | $69.09 | $2.47 – $108.97 | 144,280 | 41 |
| Central City, KY | $35.60 | $15.64 – $38.76 | 144,258 | 17 |
| Hinsdale, IL | $58.79 | $1.01 – $132.26 | 144,219 | 152 |
| Mendota, CA | $0.66 | $0.00 – $359.21 | 144,197 | 11 |
| Henderson, TN | $30.24 | $9.52 – $74.63 | 144,153 | 29 |
| Taos, NM | $117.77 | $0.00 – $496.84 | 144,148 | 66 |
| Aventura, FL | $32.15 | $0.00 – $137.30 | 144,091 | 99 |
| Northville, MI | $23.84 | $4.03 – $107.30 | 143,776 | 12 |
| New City, NY | $82.71 | $0.00 – $156.55 | 143,739 | 69 |
| Chester, VA | $53.50 | $5.22 – $122.78 | 143,675 | 69 |
| Branford, CT | $60.70 | $0.00 – $138.49 | 143,435 | 95 |
| Dakota Dunes, SD | $36.60 | $0.21 – $90.10 | 143,355 | 110 |
| Lebanon, PA | $43.43 | $0.00 – $167.84 | 143,245 | 143 |
| Columbia, LA | $0.26 | $0.00 – $10.89 | 143,191 | 17 |
| Iselin, NJ | $55.73 | $1.65 – $163.23 | 143,103 | 39 |
| West Union, OH | $52.39 | $0.00 – $87.93 | 142,751 | 25 |
| Dickinson, TX | $44.45 | $0.00 – $73.23 | 142,675 | 20 |
| Mount Kisco, NY | $97.99 | $0.00 – $190.35 | 142,536 | 101 |
| Artesia, NM | $95.36 | $11.32 – $175.42 | 142,301 | 46 |
| Brattleboro, VT | $41.35 | $0.00 – $120.12 | 142,250 | 90 |
| Sheffield, AL | $53.81 | $0.00 – $214.08 | 142,244 | 64 |
| Jurupa Valley, CA | $2.24 | $0.78 – $4.75 | 142,213 | 6 |
| Salinas, PR | $4.28 | $0.00 – $72.53 | 142,080 | 28 |
| Apache Junction, AZ | $49.86 | $0.56 – $337.11 | 141,857 | 52 |
| Inez, KY | $34.39 | $12.28 – $63.43 | 141,580 | 17 |
| Murray, UT | $58.29 | $0.00 – $530.66 | 141,570 | 172 |
| Wareham, MA | $46.61 | $0.80 – $98.77 | 141,330 | 75 |
| Oregon City, OR | $75.38 | $8.91 – $1,600 | 141,042 | 123 |
| Cut Off, LA | $17.80 | $0.00 – $90.67 | 140,962 | 17 |
| Greenville, MI | $12.70 | $0.40 – $116.18 | 140,940 | 17 |
| Bloomington, MN | $73.31 | $4.63 – $519.00 | 140,875 | 264 |
| Amory, MS | $58.89 | $0.44 – $92.26 | 140,872 | 57 |
| Griffin, GA | $79.37 | $2.44 – $130.00 | 140,830 | 31 |
| Fort Lee, NJ | $45.63 | $0.57 – $116.40 | 140,793 | 50 |
| Woodlake, CA | $6.14 | $0.00 – $32.57 | 140,764 | 12 |
| Athens, GA | $58.40 | $0.00 – $356.60 | 140,630 | 95 |
| Bergenfield, NJ | $79.80 | $1.79 – $95.07 | 140,531 | 28 |
| Ottawa, IL | $44.20 | $0.00 – $119.01 | 140,406 | 52 |
| Muscatine, IA | $15.19 | $0.00 – $81.84 | 140,325 | 71 |
| Aiea, HI | $39.33 | $0.00 – $202.17 | 140,196 | 111 |
| Reseda, CA | $21.56 | $0.00 – $1,222 | 140,173 | 67 |
| Sycamore, IL | $37.58 | $0.07 – $144.43 | 139,903 | 92 |
| Front Royal, VA | $58.85 | $3.64 – $85.26 | 139,810 | 72 |
| Bryn Mawr, PA | $41.12 | $0.00 – $184.27 | 139,791 | 91 |
| Franklinton, LA | $32.60 | $0.00 – $81.66 | 139,723 | 26 |
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.