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 |
|---|---|---|---|---|
| Sonoma, CA | $15.67 | $0.13 – $395.04 | 119,863 | 47 |
| Phenix City, AL | $60.27 | $7.33 – $224.99 | 119,777 | 27 |
| South Hill, VA | $53.31 | $6.27 – $119.38 | 119,715 | 56 |
| Sun City West, AZ | $64.46 | $9.28 – $106.24 | 119,697 | 89 |
| Kailua Kona, HI | $107.14 | $0.00 – $279.91 | 119,695 | 95 |
| Franklin, WI | $37.17 | $12.86 – $84.52 | 119,559 | 89 |
| Somerville, MA | $55.30 | $0.00 – $140.51 | 119,469 | 124 |
| West Nyack, NY | $92.20 | $1.92 – $237.96 | 119,406 | 100 |
| Denville, NJ | $57.98 | $10.69 – $113.63 | 119,375 | 44 |
| Ashland, WI | $64.31 | $11.12 – $112.75 | 119,335 | 68 |
| Lebanon, OR | $84.90 | $0.00 – $679.52 | 119,236 | 70 |
| Bridgeton, MO | $51.54 | $0.00 – $153.56 | 119,129 | 122 |
| Huntington Station, NY | $68.60 | $8.32 – $193.74 | 119,118 | 79 |
| Lares, PR | $3.71 | $0.00 – $47.94 | 119,117 | 43 |
| Elk City, OK | $86.76 | $0.00 – $127.79 | 118,754 | 42 |
| North Vernon, IN | $54.88 | $22.16 – $84.21 | 118,715 | 33 |
| Arcadia, FL | $43.01 | $0.00 – $765.94 | 118,695 | 29 |
| Gloversville, NY | $84.37 | $4.31 – $161.26 | 118,676 | 69 |
| Placentia, CA | $33.35 | $0.00 – $163.61 | 118,638 | 34 |
| Sulphur Springs, TX | $35.85 | $0.00 – $510.62 | 118,614 | 39 |
| Greenville, KY | $39.70 | $4.29 – $247.75 | 118,491 | 35 |
| Moorestown, NJ | $70.31 | $1.46 – $360.32 | 118,447 | 142 |
| Versailles, KY | $43.71 | $0.00 – $76.45 | 118,249 | 29 |
| Mount Pleasant, TX | $44.62 | $2.49 – $251.74 | 118,144 | 45 |
| Cheshire, CT | $38.58 | $0.00 – $94.82 | 118,137 | 74 |
| Burley, ID | $43.08 | $0.00 – $179.99 | 118,064 | 56 |
| Randallstown, MD | $91.63 | $5.79 – $298.72 | 117,890 | 64 |
| Fairfield, IA | $19.28 | $0.00 – $80.19 | 117,821 | 23 |
| Yankton, SD | $38.77 | $0.00 – $135.67 | 117,577 | 31 |
| Clemmons, NC | $54.20 | $0.00 – $95.17 | 117,568 | 80 |
| Redmond, OR | $41.77 | $0.00 – $985.03 | 117,456 | 107 |
| Norway, ME | $26.28 | $3.25 – $106.62 | 117,434 | 28 |
| Ashburn, VA | $64.86 | $0.00 – $124.68 | 117,303 | 81 |
| Tarboro, NC | $44.22 | $17.46 – $81.59 | 117,260 | 47 |
| Texarkana, AR | $29.10 | $0.00 – $63.12 | 117,212 | 51 |
| Johnson City, NY | $64.00 | $8.50 – $730.79 | 117,183 | 131 |
| Derry, NH | $50.55 | $0.00 – $101.61 | 117,143 | 77 |
| Port Jefferson Station, NY | $82.34 | $6.01 – $190.02 | 117,109 | 92 |
| Mooresville, IN | $59.86 | $11.86 – $98.72 | 116,906 | 82 |
| Gray, KY | $29.12 | $5.79 – $52.76 | 116,855 | 15 |
| Cushing, OK | $81.68 | $0.54 – $519.00 | 116,834 | 25 |
| Boone, NC | $56.58 | $0.44 – $101.63 | 116,526 | 101 |
| Montgomery, OH | $55.64 | $20.00 – $139.49 | 116,416 | 86 |
| Coushatta, LA | $8.76 | $0.00 – $39.69 | 116,266 | 20 |
| Wheaton, IL | $64.98 | $0.00 – $228.86 | 116,180 | 122 |
| West Seneca, NY | $61.64 | $9.21 – $166.24 | 116,138 | 113 |
| Havre, MT | $7.86 | $0.00 – $168.54 | 116,133 | 20 |
| Plainville, CT | $29.48 | $0.00 – $95.82 | 116,013 | 49 |
| Xenia, OH | $59.50 | $0.20 – $128.79 | 115,982 | 51 |
| Greenwood Village, CO | $89.36 | $0.00 – $364.77 | 115,942 | 104 |
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.