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 |
|---|---|---|---|---|
| Shenandoah, TX | $48.65 | $0.00 – $139.88 | 139,643 | 110 |
| Lauderdale Lakes, FL | $42.01 | $0.03 – $310.45 | 139,455 | 65 |
| Ripley, WV | $41.12 | $0.00 – $87.15 | 139,348 | 48 |
| Crestview, FL | $42.54 | $0.00 – $166.78 | 139,269 | 80 |
| Tuscumbia, AL | $62.29 | $0.00 – $83.37 | 138,979 | 26 |
| Yucaipa, CA | $31.78 | $0.00 – $1,118 | 138,952 | 27 |
| Fort Gratiot, MI | $52.47 | $24.29 – $70.25 | 138,806 | 14 |
| La Grange, KY | $42.66 | $14.41 – $83.08 | 138,772 | 62 |
| Springboro, OH | $59.74 | $28.57 – $148.11 | 138,560 | 79 |
| Gaffney, SC | $73.83 | $0.00 – $262.83 | 138,518 | 58 |
| Granger, IN | $58.52 | $17.71 – $126.97 | 138,431 | 83 |
| Brighton, MA | $36.07 | $0.00 – $165.49 | 138,358 | 149 |
| Coamo, PR | $7.42 | $0.00 – $51.35 | 138,275 | 34 |
| Lincoln, RI | $64.33 | $28.24 – $125.45 | 138,203 | 82 |
| Encinitas, CA | $36.24 | $0.00 – $165.77 | 138,192 | 100 |
| Radcliff, KY | $38.95 | $18.32 – $59.50 | 138,148 | 39 |
| Ionia, MI | $81.09 | $0.00 – $323.09 | 138,010 | 15 |
| South Prince George, VA | $12.52 | $0.41 – $12.60 | 137,822 | 3 |
| Sunnyside, NY | $61.06 | $0.00 – $151.93 | 137,717 | 30 |
| West Reading, PA | $49.45 | $0.00 – $99.52 | 137,685 | 149 |
| Marianna, FL | $40.33 | $0.00 – $97.12 | 137,651 | 71 |
| Kapolei, HI | $157.03 | $1.45 – $296.49 | 137,598 | 60 |
| Hastings, NE | $54.15 | $9.31 – $322.04 | 137,570 | 90 |
| Newburyport, MA | $56.18 | $0.00 – $145.31 | 137,442 | 109 |
| West Valley City, UT | $60.56 | $0.00 – $409.61 | 137,438 | 71 |
| Ludington, MI | $58.99 | $1.17 – $258.57 | 137,376 | 17 |
| Penuelas, PR | $2.44 | $0.00 – $41.85 | 137,315 | 21 |
| Healdsburg, CA | $9.74 | $0.32 – $161.33 | 137,291 | 42 |
| Bowling Green, OH | $53.32 | $4.74 – $140.57 | 137,216 | 78 |
| Waynesboro, MS | $60.92 | $6.29 – $123.84 | 137,159 | 35 |
| Covington, TN | $37.38 | $2.11 – $62.58 | 136,947 | 33 |
| Bluffton, SC | $61.39 | $1.39 – $110.27 | 136,920 | 58 |
| Coon Rapids, MN | $83.83 | $13.70 – $530.20 | 136,673 | 216 |
| Cleburne, TX | $38.48 | $0.00 – $61.91 | 136,631 | 36 |
| Tompkinsville, KY | $33.39 | $0.00 – $89.68 | 136,626 | 21 |
| Avenel, NJ | $44.34 | $1.00 – $98.51 | 136,554 | 19 |
| Campton, KY | $30.01 | $7.41 – $44.96 | 136,434 | 19 |
| South Williamson, KY | $29.14 | $5.49 – $71.64 | 136,368 | 33 |
| Biddeford, ME | $34.38 | $0.00 – $93.71 | 136,297 | 152 |
| Wyomissing, PA | $53.27 | $0.00 – $139.61 | 136,210 | 173 |
| Eagle Pass, TX | $23.43 | $0.00 – $43.05 | 136,087 | 41 |
| Keyser, WV | $43.99 | $0.38 – $189.99 | 135,948 | 35 |
| Centreville, AL | $5.38 | $0.00 – $199.91 | 135,692 | 54 |
| Lebanon, KY | $33.65 | $14.37 – $56.18 | 135,683 | 47 |
| Carson, CA | $12.76 | $0.00 – $225.41 | 135,535 | 60 |
| Galax, VA | $53.42 | $3.28 – $132.63 | 135,519 | 71 |
| West Babylon, NY | $61.73 | $10.41 – $163.87 | 135,260 | 42 |
| Ridgewood, NJ | $60.43 | $0.00 – $144.83 | 135,174 | 65 |
| Brookings, OR | $49.87 | $0.00 – $130.79 | 135,138 | 35 |
| Pixley, CA | $5.56 | $0.05 – $17.14 | 135,089 | 4 |
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.