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 |
|---|---|---|---|---|
| Amityville, NY | $68.01 | $5.62 – $140.81 | 123,441 | 58 |
| Pell City, AL | $66.77 | $0.00 – $800.24 | 123,402 | 58 |
| Madison, WV | $14.78 | $0.00 – $106.41 | 123,267 | 41 |
| Riverdale, MD | $89.30 | $0.00 – $243.16 | 123,236 | 37 |
| Lawrenceville, NJ | $43.81 | $0.00 – $129.01 | 123,187 | 91 |
| Ashland, OR | $66.24 | $0.12 – $310.37 | 123,167 | 82 |
| New Square, NY | $35.97 | $0.00 – $133.53 | 123,150 | 25 |
| Bucyrus, OH | $53.37 | $0.00 – $95.50 | 123,068 | 34 |
| North Babylon, NY | $75.93 | $38.66 – $142.30 | 123,054 | 44 |
| Anthony, NM | $88.38 | $31.70 – $176.00 | 122,776 | 18 |
| Presque Isle, ME | $32.81 | $0.00 – $267.66 | 122,681 | 81 |
| Georgetown, DE | $46.59 | $0.00 – $200.52 | 122,476 | 49 |
| Clarksburg, WV | $31.50 | $0.00 – $81.50 | 122,455 | 55 |
| Stuart, FL | $39.34 | $0.00 – $703.09 | 122,381 | 134 |
| Washington, MO | $68.78 | $15.67 – $159.28 | 122,314 | 128 |
| Saint Clair Shores, MI | $57.39 | $0.00 – $275.08 | 122,313 | 44 |
| Cordele, GA | $100.40 | $24.08 – $118.11 | 122,311 | 21 |
| Tallmadge, OH | $53.88 | $21.94 – $92.43 | 122,200 | 49 |
| Woodhaven, NY | $55.77 | $4.02 – $110.97 | 122,125 | 18 |
| Fayetteville, NY | $67.34 | $5.42 – $191.13 | 122,084 | 88 |
| Clinton, MO | $46.81 | $0.00 – $137.44 | 122,031 | 60 |
| Rayne, LA | $24.63 | $0.10 – $60.77 | 121,822 | 12 |
| Dundalk, MD | $87.24 | $0.00 – $176.85 | 121,811 | 37 |
| Getzville, NY | $108.92 | $39.48 – $109.24 | 121,767 | 5 |
| Alpena, MI | $96.60 | $0.30 – $266.23 | 121,651 | 26 |
| Rochester, MI | $59.53 | $0.00 – $94.64 | 121,590 | 23 |
| Castroville, CA | $17.21 | $0.12 – $28.16 | 121,567 | 6 |
| Santa Isabel, PR | $8.69 | $0.00 – $71.93 | 121,463 | 26 |
| Wentzville, MO | $43.78 | $0.00 – $149.61 | 121,443 | 82 |
| Ossining, NY | $97.36 | $33.12 – $190.04 | 121,382 | 37 |
| Kirkland, WA | $58.35 | $0.00 – $152.14 | 121,238 | 174 |
| Kingston, PA | $41.62 | $0.42 – $134.87 | 121,200 | 66 |
| Juncos, PR | $6.50 | $0.00 – $105.17 | 121,161 | 33 |
| Union City, CA | $37.04 | $0.00 – $464.01 | 121,151 | 100 |
| Martin, TN | $38.51 | $0.00 – $68.88 | 121,059 | 33 |
| Spencer, IA | $53.75 | $0.00 – $103.93 | 120,835 | 65 |
| Lajas, PR | $0.36 | $0.00 – $2.13 | 120,804 | 26 |
| Ellicott City, MD | $69.84 | $0.00 – $186.98 | 120,760 | 95 |
| Titusville, FL | $56.41 | $0.00 – $432.59 | 120,727 | 74 |
| Hindman, KY | $30.31 | $2.59 – $55.65 | 120,687 | 20 |
| Gig Harbor, WA | $55.55 | $0.00 – $142.42 | 120,683 | 111 |
| Silver City, NM | $69.45 | $0.00 – $208.31 | 120,632 | 68 |
| Springfield, NJ | $51.32 | $1.69 – $105.75 | 120,383 | 74 |
| Dorado, PR | $24.06 | $0.00 – $94.76 | 120,340 | 49 |
| Medford, MA | $80.01 | $0.00 – $195.07 | 120,130 | 106 |
| Homer, LA | $17.35 | $0.00 – $52.46 | 120,113 | 14 |
| Fairmont, WV | $32.75 | $0.00 – $103.20 | 120,059 | 84 |
| Las Vegas, NM | $86.37 | $0.00 – $189.53 | 119,980 | 49 |
| Olathe, KS | $45.85 | $0.00 – $347.27 | 119,978 | 166 |
| Lone Tree, CO | $108.10 | $0.00 – $501.95 | 119,880 | 193 |
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.