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 |
|---|---|---|---|---|
| Pomona, NY | $109.40 | $6.94 – $186.42 | 104,802 | 47 |
| Forrest City, AR | $38.30 | $7.04 – $89.29 | 104,674 | 27 |
| Sturgis, MI | $43.68 | $1.86 – $57.72 | 104,620 | 14 |
| Watertown, CT | $54.65 | $10.47 – $87.63 | 104,592 | 26 |
| Canton, NY | $71.75 | $0.00 – $214.64 | 104,558 | 57 |
| Bemidji, MN | $85.91 | $13.70 – $694.63 | 104,486 | 123 |
| South Shore, KY | $30.63 | $0.00 – $53.27 | 104,440 | 14 |
| Toa Alta, PR | $5.13 | $0.00 – $94.71 | 104,269 | 25 |
| South Portland, ME | $43.25 | $0.00 – $328.06 | 104,221 | 158 |
| South Burlington, VT | $42.19 | $0.00 – $125.83 | 104,203 | 114 |
| Rice Lake, WI | $48.02 | $3.16 – $168.85 | 104,186 | 78 |
| San Clemente, CA | $29.87 | $0.00 – $427.82 | 104,118 | 49 |
| Benton, KY | $32.69 | $1.64 – $68.04 | 104,098 | 41 |
| Hood River, OR | $25.57 | $0.00 – $159.28 | 104,081 | 89 |
| Knox, IN | $47.41 | $34.92 – $79.98 | 103,890 | 17 |
| Loveland, OH | $36.14 | $0.00 – $159.97 | 103,827 | 39 |
| Stillwater, OK | $95.57 | $4.63 – $648.11 | 103,805 | 87 |
| Uniontown, OH | $51.21 | $21.02 – $117.30 | 103,712 | 75 |
| Lynnwood, WA | $47.28 | $5.17 – $125.43 | 103,665 | 82 |
| Magee, MS | $59.60 | $3.43 – $91.50 | 103,649 | 31 |
| Ripley, TN | $34.06 | $14.86 – $53.83 | 103,641 | 20 |
| Havre De Grace, MD | $86.81 | $0.00 – $178.73 | 103,612 | 65 |
| Meadville, PA | $39.91 | $0.00 – $80.90 | 103,506 | 94 |
| Beaver Dam, WI | $44.21 | $2.07 – $93.35 | 103,494 | 71 |
| Osage Beach, MO | $67.07 | $7.99 – $503.53 | 103,471 | 70 |
| Humboldt, TN | $47.74 | $12.18 – $122.27 | 103,324 | 23 |
| Harrogate, TN | $27.67 | $11.27 – $52.27 | 103,257 | 23 |
| Claremont, CA | $46.94 | $0.07 – $150.26 | 103,214 | 48 |
| Golden, CO | $68.41 | $0.00 – $272.62 | 103,069 | 116 |
| Urbandale, IA | $33.93 | $0.00 – $230.74 | 103,029 | 68 |
| Porter, TX | $36.38 | $0.00 – $109.36 | 103,015 | 14 |
| University Place, WA | $57.14 | $0.27 – $108.72 | 103,001 | 45 |
| Rockaway Beach, NY | $45.97 | $13.04 – $80.92 | 102,964 | 7 |
| Loxahatchee, FL | $88.20 | $0.00 – $137.79 | 102,729 | 56 |
| Jackson, NJ | $63.21 | $14.32 – $98.82 | 102,631 | 31 |
| Hinesville, GA | $63.77 | $1.57 – $200.36 | 102,617 | 28 |
| Guttenberg, NJ | $47.12 | $7.98 – $71.75 | 102,600 | 8 |
| Pleasant Hill, CA | $38.25 | $0.00 – $807.20 | 102,372 | 45 |
| Monroe, WA | $61.37 | $0.00 – $128.69 | 102,318 | 64 |
| Anasco, PR | $5.38 | $0.00 – $66.48 | 102,298 | 28 |
| Bellaire, TX | $44.96 | $0.00 – $140.05 | 102,213 | 77 |
| Newark, CA | $26.74 | $2.58 – $281.94 | 102,175 | 19 |
| Goodlettsville, TN | $42.87 | $0.00 – $100.60 | 102,144 | 44 |
| Cambria Heights, NY | $61.12 | $0.00 – $84.59 | 102,055 | 25 |
| Linton, IN | $53.95 | $8.89 – $107.30 | 101,961 | 34 |
| Lugoff, SC | $82.44 | $25.90 – $300.00 | 101,852 | 30 |
| Terrytown, LA | $30.09 | $0.00 – $78.50 | 101,806 | 29 |
| De Queen, AR | $47.94 | $0.00 – $281.23 | 101,792 | 26 |
| Lihue, HI | $34.70 | $2.77 – $222.80 | 101,790 | 64 |
| Burleson, TX | $39.69 | $0.00 – $91.13 | 101,702 | 66 |
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.