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 |
|---|---|---|---|---|
| Evansville, IN | $55.98 | $0.00 – $293.39 | 1,356,723 | 663 |
| Waterbury, CT | $43.78 | $0.00 – $142.15 | 1,350,667 | 474 |
| Hazard, KY | $33.20 | $3.19 – $126.14 | 1,350,503 | 220 |
| Wichita, KS | $59.08 | $0.00 – $297.52 | 1,344,372 | 1004 |
| Bridgeport, CT | $36.87 | $0.00 – $195.19 | 1,340,019 | 495 |
| Lakewood, NJ | $46.07 | $0.00 – $191.84 | 1,338,706 | 201 |
| Jackson, TN | $34.02 | $0.00 – $108.59 | 1,335,861 | 532 |
| Vancouver, WA | $62.80 | $0.00 – $1,073 | 1,333,081 | 1005 |
| Fremont, CA | $37.21 | $0.00 – $714.21 | 1,303,829 | 366 |
| Kalamazoo, MI | $46.58 | $0.00 – $191.64 | 1,300,383 | 102 |
| Loma Linda, CA | $44.34 | $0.00 – $1,093 | 1,299,991 | 859 |
| Wilmington, NC | $55.56 | $0.00 – $439.94 | 1,298,205 | 849 |
| Mobile, AL | $59.87 | $0.00 – $1,540 | 1,293,686 | 828 |
| Torrance, CA | $19.58 | $0.00 – $1,242 | 1,291,612 | 541 |
| Fountain Valley, CA | $37.39 | $0.00 – $432.57 | 1,288,022 | 344 |
| Salem, OR | $58.60 | $0.00 – $1,870 | 1,284,559 | 649 |
| Rockville, MD | $58.07 | $-1.62 – $522.52 | 1,282,599 | 494 |
| Pueblo, CO | $101.81 | $0.00 – $345.83 | 1,279,905 | 499 |
| Pikeville, KY | $34.50 | $0.00 – $99.05 | 1,279,513 | 264 |
| Canton, OH | $46.47 | $0.00 – $166.21 | 1,276,960 | 548 |
| Hemet, CA | $36.81 | $0.00 – $1,574 | 1,274,475 | 190 |
| Spartanburg, SC | $67.79 | $0.00 – $341.29 | 1,272,684 | 525 |
| Hammond, LA | $28.33 | $0.00 – $94.25 | 1,268,185 | 301 |
| Oroville, CA | $14.21 | $0.00 – $1,015 | 1,267,399 | 126 |
| Laredo, TX | $30.47 | $0.00 – $129.67 | 1,262,592 | 264 |
| Johnson City, TN | $41.00 | $0.00 – $137.23 | 1,254,454 | 696 |
| Porterville, CA | $10.91 | $0.00 – $797.74 | 1,247,200 | 140 |
| Salt Lake City, UT | $79.84 | $0.00 – $785.94 | 1,234,373 | 1011 |
| Hattiesburg, MS | $53.39 | $0.00 – $834.86 | 1,233,411 | 528 |
| Durham, NC | $53.48 | $0.00 – $318.75 | 1,229,002 | 1194 |
| Santa Maria, CA | $37.09 | $0.00 – $563.35 | 1,228,678 | 261 |
| Rockford, IL | $30.80 | $0.00 – $400.00 | 1,227,594 | 556 |
| Camden, NJ | $82.72 | $0.00 – $402.14 | 1,223,074 | 571 |
| Greenville, NC | $53.22 | $0.00 – $196.43 | 1,217,510 | 800 |
| El Cajon, CA | $12.72 | $0.00 – $1,076 | 1,211,939 | 210 |
| Gilbert, AZ | $60.84 | $0.00 – $318.75 | 1,211,376 | 691 |
| Hagerstown, MD | $78.99 | $0.00 – $438.11 | 1,200,926 | 455 |
| Portsmouth, OH | $49.74 | $0.00 – $163.20 | 1,198,712 | 251 |
| Beckley, WV | $39.82 | $0.00 – $84.53 | 1,189,579 | 276 |
| Madison, WI | $49.22 | $0.00 – $660.13 | 1,187,844 | 1194 |
| Tempe, AZ | $53.90 | $0.00 – $1,032 | 1,176,378 | 347 |
| Wilmington, DE | $55.68 | $0.00 – $262.09 | 1,174,146 | 633 |
| Terre Haute, IN | $53.23 | $0.00 – $157.59 | 1,168,725 | 361 |
| Owensboro, KY | $36.73 | $5.01 – $101.68 | 1,157,739 | 408 |
| Cedar Rapids, IA | $32.20 | $0.00 – $121.94 | 1,155,232 | 513 |
| Springfield, IL | $38.46 | $0.00 – $305.88 | 1,154,993 | 764 |
| Westminster, CA | $26.97 | $0.00 – $868.44 | 1,150,672 | 188 |
| Asheville, NC | $57.01 | $0.00 – $761.46 | 1,148,926 | 840 |
| Hanford, CA | $7.20 | $0.00 – $992.14 | 1,137,780 | 140 |
| Lansing, MI | $62.29 | $0.00 – $318.75 | 1,122,100 | 157 |
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.