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 |
|---|---|---|---|---|
| Paradise, CA | $18.20 | $0.00 – $607.28 | 135,057 | 35 |
| Oceana, WV | $4.92 | $0.00 – $44.25 | 135,002 | 7 |
| Russellville, AL | $39.27 | $0.00 – $193.54 | 134,838 | 41 |
| Pontotoc, MS | $64.06 | $3.71 – $149.50 | 134,671 | 32 |
| Arverne, NY | $61.78 | $9.33 – $121.36 | 134,653 | 22 |
| Cedar Falls, IA | $32.68 | $0.00 – $63.40 | 134,644 | 85 |
| Kearny, NJ | $42.65 | $3.33 – $79.95 | 134,504 | 26 |
| Winnfield, LA | $6.80 | $0.00 – $37.12 | 134,442 | 18 |
| Maitland, FL | $92.99 | $0.00 – $294.99 | 134,357 | 71 |
| Long Branch, NJ | $52.72 | $0.00 – $118.89 | 134,352 | 66 |
| Norton Shores, MI | $62.39 | $3.88 – $98.73 | 134,086 | 17 |
| Tomball, TX | $41.58 | $0.00 – $94.33 | 134,078 | 68 |
| Oviedo, FL | $55.12 | $0.00 – $164.93 | 133,823 | 67 |
| Ponca City, OK | $116.37 | $3.39 – $719.00 | 133,750 | 56 |
| Kent, OH | $59.66 | $2.62 – $318.75 | 133,587 | 80 |
| East Bernstadt, KY | $25.63 | $22.34 – $32.12 | 133,448 | 10 |
| Andalusia, AL | $29.91 | $0.00 – $209.31 | 133,415 | 45 |
| Lutherville, MD | $77.25 | $0.00 – $257.00 | 133,414 | 115 |
| Monticello, AR | $33.65 | $0.00 – $95.24 | 133,168 | 38 |
| Calhoun, GA | $48.50 | $11.68 – $93.54 | 133,168 | 93 |
| Port Orchard, WA | $51.85 | $0.00 – $121.31 | 133,105 | 72 |
| La Place, LA | $33.81 | $0.00 – $69.79 | 133,059 | 44 |
| Scottsbluff, NE | $54.74 | $0.00 – $254.89 | 133,054 | 99 |
| Brownsville, TN | $33.24 | $15.77 – $50.19 | 133,006 | 19 |
| St Augustine, FL | $54.50 | $0.00 – $427.00 | 132,888 | 124 |
| Owasso, OK | $74.66 | $0.00 – $167.78 | 132,752 | 76 |
| Temple Terrace, FL | $36.56 | $0.00 – $147.58 | 132,635 | 90 |
| Brooksville, FL | $57.88 | $0.00 – $145.08 | 132,535 | 81 |
| Ciales, PR | $4.08 | $0.00 – $33.23 | 132,376 | 17 |
| Cottonport, LA | $0.44 | $0.00 – $3.21 | 132,310 | 10 |
| Somersworth, NH | $24.63 | $0.00 – $66.65 | 132,145 | 75 |
| Canton, IL | $3.35 | $0.00 – $95.14 | 132,083 | 33 |
| Norfolk, NE | $55.63 | $0.00 – $190.39 | 132,004 | 124 |
| Sweetwater, TN | $34.04 | $5.02 – $48.80 | 131,694 | 33 |
| Upper Marlboro, MD | $96.70 | $0.00 – $239.94 | 131,663 | 111 |
| Greensburg, KY | $30.89 | $18.20 – $45.65 | 131,574 | 24 |
| Norwich, NY | $109.21 | $11.92 – $142.52 | 131,478 | 44 |
| Greenville, TX | $40.91 | $0.00 – $79.00 | 131,299 | 64 |
| Newton, NJ | $52.10 | $0.00 – $109.79 | 131,295 | 48 |
| Reston, VA | $62.69 | $0.00 – $158.74 | 131,243 | 128 |
| Beaver, WV | $59.46 | $13.22 – $80.41 | 131,236 | 13 |
| Bolivar, TN | $31.00 | $3.99 – $62.63 | 131,179 | 36 |
| Scarsdale, NY | $89.22 | $0.00 – $181.80 | 131,123 | 66 |
| Tukwila, WA | $21.91 | $0.00 – $92.19 | 130,997 | 42 |
| Methuen, MA | $45.41 | $1.18 – $157.57 | 130,777 | 76 |
| Tamuning, GU | $73.89 | $0.00 – $140.39 | 130,648 | 93 |
| Talladega, AL | $20.51 | $0.00 – $230.80 | 130,616 | 37 |
| Lake Mary, FL | $48.41 | $0.00 – $188.51 | 130,552 | 119 |
| Shelton, WA | $62.83 | $0.00 – $122.14 | 130,413 | 81 |
| Totowa, NJ | $63.21 | $4.10 – $108.00 | 130,167 | 23 |
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.