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 |
|---|---|---|---|---|
| Elk Grove Village, IL | $61.26 | $0.00 – $113.62 | 96,558 | 90 |
| Lebanon, VA | $53.89 | $0.00 – $138.46 | 96,553 | 38 |
| Dekalb, IL | $50.73 | $0.00 – $85.78 | 96,512 | 56 |
| Damariscotta, ME | $15.74 | $2.22 – $135.62 | 96,475 | 26 |
| Eastpointe, MI | $66.62 | $3.90 – $83.52 | 96,432 | 17 |
| Brentwood, CA | $37.88 | $0.00 – $161.59 | 96,400 | 40 |
| Smithville, TN | $33.17 | $11.36 – $48.96 | 96,365 | 17 |
| Loiza, PR | $1.39 | $0.00 – $53.00 | 96,357 | 15 |
| Pottstown, PA | $39.94 | $0.00 – $111.65 | 96,350 | 88 |
| London, OH | $46.75 | $0.35 – $116.57 | 96,179 | 49 |
| Charleston, IL | $47.48 | $0.00 – $79.75 | 96,128 | 26 |
| Paw Paw, MI | $17.54 | $0.00 – $79.94 | 96,112 | 7 |
| Murphy, NC | $74.06 | $0.00 – $512.63 | 95,996 | 39 |
| Stanton, KY | $33.67 | $12.32 – $40.44 | 95,920 | 15 |
| Falmouth, MA | $57.92 | $3.10 – $195.54 | 95,899 | 72 |
| Paris, TX | $44.94 | $0.00 – $509.72 | 95,855 | 98 |
| Benson, NC | $34.90 | $0.00 – $59.60 | 95,851 | 29 |
| Fort Mill, SC | $68.71 | $0.00 – $250.38 | 95,838 | 79 |
| Bedford, NH | $39.32 | $0.00 – $712.92 | 95,816 | 125 |
| Wexford, PA | $56.95 | $5.40 – $323.76 | 95,752 | 93 |
| Kennesaw, GA | $56.17 | $0.17 – $223.12 | 95,683 | 36 |
| Mason, MI | $49.92 | $0.00 – $72.39 | 95,665 | 12 |
| Athens, TX | $42.26 | $0.00 – $82.44 | 95,504 | 48 |
| Hazleton, PA | $47.66 | $0.00 – $222.24 | 95,425 | 49 |
| Barranquitas, PR | $3.25 | $0.00 – $80.11 | 95,424 | 20 |
| Lehigh Acres, FL | $39.79 | $0.00 – $116.56 | 95,386 | 59 |
| Stearns, KY | $28.81 | $11.57 – $95.23 | 95,243 | 14 |
| Houghton Lake, MI | $11.45 | $11.45 – $11.45 | 95,239 | 1 |
| Mansfield Center, CT | $63.16 | $0.00 – $98.31 | 95,182 | 35 |
| Windsor, CT | $41.74 | $0.00 – $359.83 | 95,170 | 31 |
| Macomb, IL | $31.93 | $0.00 – $109.57 | 95,150 | 54 |
| Bridgewater, NJ | $55.52 | $6.82 – $188.83 | 95,001 | 91 |
| East Greenwich, RI | $66.59 | $10.47 – $165.59 | 94,810 | 119 |
| Milwaukie, OR | $61.72 | $12.19 – $281.97 | 94,762 | 81 |
| Salem, OH | $42.70 | $6.51 – $99.19 | 94,742 | 55 |
| Hugo, OK | $159.96 | $0.00 – $688.17 | 94,741 | 24 |
| Mountain City, TN | $38.77 | $5.99 – $60.58 | 94,733 | 29 |
| Saint Johns, MI | $50.37 | $37.50 – $120.04 | 94,730 | 6 |
| Freedom, CA | $17.66 | $0.22 – $99.00 | 94,707 | 25 |
| Leavenworth, KS | $50.27 | $0.00 – $297.81 | 94,706 | 50 |
| Hanover, PA | $44.79 | $0.00 – $124.44 | 94,639 | 95 |
| High Springs, FL | $24.72 | $0.07 – $41.08 | 94,489 | 12 |
| Auburn, MA | $61.16 | $7.20 – $217.04 | 94,469 | 84 |
| Raynham, MA | $45.09 | $11.86 – $128.83 | 94,399 | 40 |
| Pompano Beach, FL | $46.03 | $0.00 – $115.08 | 94,396 | 58 |
| Plymouth, IN | $51.00 | $11.96 – $85.20 | 94,393 | 44 |
| Key Biscayne, FL | $38.58 | $0.00 – $48.77 | 94,344 | 5 |
| Blue Ash, OH | $58.99 | $0.00 – $135.06 | 94,343 | 74 |
| Lakeside, CA | $6.38 | $0.06 – $57.83 | 94,246 | 15 |
| Pekin, IL | $42.04 | $0.00 – $75.96 | 94,229 | 41 |
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.