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 |
|---|---|---|---|---|
| Denison, TX | $48.61 | $0.00 – $139.62 | 101,612 | 77 |
| Desert Hot Springs, CA | $2.16 | $0.28 – $127.33 | 101,604 | 13 |
| Angola, IN | $62.82 | $23.60 – $103.16 | 101,538 | 54 |
| Desoto, TX | $40.00 | $0.00 – $216.63 | 101,528 | 57 |
| Sicklerville, NJ | $52.52 | $0.00 – $160.00 | 101,493 | 39 |
| Gonzales, CA | $9.57 | $0.17 – $105.17 | 101,428 | 11 |
| Indiana, PA | $44.54 | $0.00 – $106.75 | 101,386 | 86 |
| San Dimas, CA | $48.36 | $0.00 – $919.51 | 101,314 | 63 |
| North Syracuse, NY | $67.66 | $0.00 – $136.79 | 101,268 | 56 |
| Keizer, OR | $78.32 | $4.09 – $196.72 | 101,266 | 40 |
| Taylorville, IL | $3.37 | $0.00 – $47.11 | 101,220 | 23 |
| Ogdensburg, NY | $98.81 | $0.18 – $251.43 | 101,210 | 59 |
| Marina Del Rey, CA | $32.82 | $0.00 – $182.81 | 101,025 | 55 |
| Wadsworth, OH | $55.56 | $2.38 – $80.04 | 101,025 | 50 |
| Warrenton, VA | $58.97 | $8.66 – $109.85 | 101,008 | 77 |
| Statesboro, GA | $42.94 | $3.54 – $104.73 | 100,946 | 41 |
| Alabaster, AL | $66.94 | $0.00 – $133.78 | 100,887 | 54 |
| Hobart, IN | $51.35 | $14.06 – $94.59 | 100,857 | 75 |
| Tipton, CA | $4.33 | $1.98 – $19.26 | 100,852 | 3 |
| Ennis, TX | $39.89 | $4.01 – $54.16 | 100,802 | 14 |
| Riverside, RI | $56.13 | $0.00 – $107.11 | 100,792 | 109 |
| Banning, CA | $32.93 | $0.00 – $1,722 | 100,556 | 54 |
| Carlsbad, CA | $38.23 | $0.00 – $190.56 | 100,555 | 94 |
| Woodridge, IL | $52.26 | $0.00 – $318.75 | 100,550 | 45 |
| Pacoima, CA | $15.53 | $0.00 – $1,105 | 100,549 | 23 |
| King, NC | $63.21 | $20.16 – $107.26 | 100,481 | 42 |
| Menifee, CA | $19.28 | $0.00 – $131.44 | 100,438 | 37 |
| Hastings, MI | $50.91 | $5.43 – $188.47 | 100,338 | 19 |
| Farmingville, NY | $127.55 | $32.14 – $140.22 | 100,282 | 13 |
| Wheaton, MD | $84.06 | $1.02 – $129.24 | 100,223 | 34 |
| Bloomington, CA | $9.05 | $0.00 – $50.73 | 100,215 | 14 |
| Castle Rock, CO | $72.66 | $0.00 – $389.46 | 100,170 | 115 |
| Brownwood, TX | $41.53 | $0.00 – $143.64 | 100,052 | 47 |
| Palmer, AK | $119.69 | $0.00 – $799.99 | 99,963 | 76 |
| Brookfield, WI | $34.06 | $0.00 – $133.35 | 99,961 | 130 |
| Bryan, TX | $45.46 | $0.00 – $227.63 | 99,937 | 103 |
| Dresden, TN | $27.97 | $12.59 – $46.20 | 99,917 | 16 |
| Sequim, WA | $34.50 | $0.31 – $436.51 | 99,708 | 72 |
| Huntingdon, TN | $36.82 | $10.53 – $57.24 | 99,637 | 30 |
| Guayanilla, PR | $4.53 | $0.00 – $35.98 | 99,623 | 14 |
| Kaneohe, HI | $38.51 | $0.00 – $287.69 | 99,564 | 45 |
| Westport, CT | $48.73 | $0.00 – $143.12 | 99,486 | 78 |
| Batesville, MS | $59.72 | $0.00 – $156.35 | 99,474 | 52 |
| Hackettstown, NJ | $49.50 | $0.00 – $115.11 | 99,466 | 53 |
| Chesterfield, MO | $63.08 | $5.44 – $318.46 | 99,458 | 122 |
| Watertown, MA | $73.13 | $0.00 – $136.75 | 99,439 | 53 |
| Manistee, MI | $68.53 | $1.01 – $353.20 | 99,394 | 18 |
| Olney, MD | $89.41 | $0.00 – $164.70 | 99,366 | 69 |
| Claremore, OK | $111.23 | $0.00 – $653.19 | 99,255 | 66 |
| St Clair Shores, MI | $61.25 | $36.02 – $68.70 | 99,255 | 6 |
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.