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 |
|---|---|---|---|---|
| London, KY | $33.74 | $0.00 – $92.21 | 1,120,887 | 241 |
| Fall River, MA | $45.39 | $0.00 – $268.48 | 1,119,590 | 466 |
| Downey, CA | $25.05 | $0.00 – $1,157 | 1,115,012 | 361 |
| Glen Allen, VA | $71.95 | $0.94 – $123.90 | 1,114,614 | 125 |
| Cambridge, MA | $95.08 | $0.00 – $175.81 | 1,113,324 | 373 |
| Montgomery, AL | $90.63 | $0.00 – $2,019 | 1,110,267 | 519 |
| Youngstown, OH | $47.74 | $0.00 – $318.75 | 1,110,251 | 441 |
| Moreno Valley, CA | $12.45 | $0.00 – $2,014 | 1,109,046 | 265 |
| Virginia Beach, VA | $58.40 | $0.00 – $413.93 | 1,108,476 | 806 |
| Minneapolis, MN | $110.86 | $0.00 – $770.83 | 1,106,975 | 1703 |
| Silver Spring, MD | $83.74 | $0.00 – $370.33 | 1,106,108 | 510 |
| Lima, OH | $37.97 | $0.00 – $628.43 | 1,104,248 | 435 |
| Elizabethtown, KY | $38.83 | $0.82 – $671.07 | 1,102,233 | 296 |
| Forest Hills, NY | $71.31 | $0.00 – $218.54 | 1,096,765 | 288 |
| Corona, CA | $38.02 | $0.00 – $1,735 | 1,093,171 | 248 |
| Pomona, CA | $29.82 | $0.00 – $1,256 | 1,091,740 | 354 |
| Fontana, CA | $28.02 | $0.00 – $858.98 | 1,091,402 | 587 |
| Arecibo, PR | $7.46 | $0.00 – $131.55 | 1,090,216 | 221 |
| Slidell, LA | $36.71 | $0.00 – $103.90 | 1,074,695 | 288 |
| West Covina, CA | $18.59 | $0.00 – $1,154 | 1,073,885 | 266 |
| Covington, LA | $36.36 | $0.00 – $284.04 | 1,064,764 | 349 |
| Peoria, IL | $44.09 | $0.00 – $677.17 | 1,063,890 | 701 |
| Zanesville, OH | $46.29 | $0.59 – $318.75 | 1,061,712 | 302 |
| Hialeah, FL | $31.22 | $0.00 – $309.64 | 1,061,174 | 446 |
| Florence, SC | $66.21 | $0.00 – $237.42 | 1,055,142 | 436 |
| Elizabeth, NJ | $46.75 | $0.00 – $249.05 | 1,054,219 | 157 |
| Victorville, CA | $40.17 | $0.00 – $968.92 | 1,045,853 | 251 |
| Caguas, PR | $21.20 | $0.00 – $120.92 | 1,042,078 | 363 |
| Boise, ID | $55.91 | $-0.63 – $1,037 | 1,041,822 | 998 |
| Brockton, MA | $67.28 | $0.00 – $373.85 | 1,041,113 | 422 |
| Pasadena, CA | $21.48 | $0.00 – $1,232 | 1,036,760 | 466 |
| Murfreesboro, TN | $38.88 | $0.00 – $293.11 | 1,033,498 | 488 |
| Warren, MI | $59.97 | $0.00 – $123.93 | 1,025,133 | 121 |
| Yakima, WA | $40.66 | $0.00 – $210.80 | 1,024,749 | 470 |
| Chillicothe, OH | $53.95 | $0.00 – $153.96 | 1,012,381 | 314 |
| Albany, NY | $75.72 | $0.00 – $244.87 | 1,010,207 | 888 |
| Mayaguez, PR | $16.67 | $0.00 – $142.21 | 1,006,098 | 318 |
| Kingsport, TN | $43.89 | $0.96 – $488.43 | 1,005,838 | 470 |
| Cookeville, TN | $38.32 | $0.00 – $149.06 | 1,005,828 | 316 |
| Warren, OH | $53.11 | $0.00 – $115.35 | 1,005,699 | 258 |
| Lancaster, CA | $31.42 | $0.00 – $972.78 | 1,000,906 | 367 |
| Van Nuys, CA | $19.24 | $0.00 – $1,229 | 999,834 | 277 |
| Huntington Beach, CA | $31.95 | $0.00 – $181.66 | 987,938 | 222 |
| Jacksonville, NC | $52.35 | $0.00 – $110.73 | 987,055 | 245 |
| Somerset, KY | $36.93 | $0.00 – $334.28 | 986,284 | 235 |
| Reno, NV | $58.44 | $0.00 – $323.58 | 986,001 | 980 |
| Irvine, CA | $41.92 | $0.00 – $320.15 | 985,384 | 402 |
| Redlands, CA | $66.05 | $0.00 – $1,195 | 982,704 | 257 |
| Yonkers, NY | $84.02 | $0.00 – $227.30 | 981,343 | 367 |
| Santa Cruz, CA | $33.23 | $0.00 – $214.70 | 980,453 | 334 |
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.