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 |
|---|---|---|---|---|
| Cliffside Park, NJ | $60.26 | $0.38 – $140.06 | 94,178 | 38 |
| Bethpage, NY | $77.69 | $0.87 – $318.75 | 94,144 | 99 |
| Wintersville, OH | $44.17 | $3.39 – $72.78 | 94,097 | 34 |
| Plainfield, IN | $62.20 | $0.00 – $107.93 | 93,980 | 62 |
| Elkins Park, PA | $33.62 | $0.00 – $73.78 | 93,976 | 61 |
| Murrells Inlet, SC | $66.84 | $0.79 – $345.00 | 93,899 | 82 |
| Santa Teresa, NM | $84.01 | $6.05 – $175.39 | 93,803 | 17 |
| Northport, AL | $48.20 | $0.00 – $1,866 | 93,780 | 73 |
| Kinder, LA | $5.46 | $0.00 – $35.59 | 93,758 | 11 |
| Burkesville, KY | $25.05 | $6.13 – $51.93 | 93,610 | 17 |
| Palatka, FL | $43.16 | $0.00 – $365.85 | 93,597 | 60 |
| River Ridge, LA | $37.09 | $0.00 – $80.14 | 93,572 | 28 |
| Broussard, LA | $46.14 | $13.93 – $79.00 | 93,531 | 22 |
| Burnsville, MN | $85.03 | $1.05 – $270.01 | 93,437 | 180 |
| Nipomo, CA | $5.01 | $0.00 – $62.12 | 93,431 | 21 |
| Lombard, IL | $50.83 | $0.36 – $110.00 | 93,379 | 78 |
| Antigo, WI | $82.56 | $8.80 – $120.53 | 93,329 | 27 |
| Poland, OH | $38.62 | $19.07 – $88.41 | 93,279 | 61 |
| Midwest City, OK | $108.97 | $0.00 – $716.13 | 93,246 | 88 |
| Morrisville, VT | $22.09 | $0.00 – $552.55 | 93,240 | 51 |
| Lathrup Village, MI | $58.93 | $1.43 – $78.76 | 93,184 | 15 |
| California, MD | $81.69 | $43.08 – $120.92 | 93,150 | 30 |
| Providence, KY | $34.08 | $8.38 – $47.70 | 93,148 | 21 |
| Moraine, OH | $84.72 | $0.00 – $254.08 | 93,100 | 46 |
| Livingston, TX | $41.89 | $0.00 – $288.65 | 93,039 | 29 |
| Blacksburg, SC | $53.36 | $51.46 – $60.10 | 93,022 | 3 |
| Holland, OH | $58.81 | $0.00 – $105.31 | 92,911 | 39 |
| Lecanto, FL | $44.35 | $0.00 – $183.11 | 92,886 | 42 |
| Atlantic, IA | $17.85 | $0.00 – $67.18 | 92,848 | 30 |
| Romney, WV | $26.85 | $0.00 – $59.68 | 92,823 | 25 |
| Oxford, OH | $41.88 | $4.11 – $134.00 | 92,741 | 50 |
| West Point, MS | $65.03 | $0.00 – $115.99 | 92,735 | 37 |
| Greenlawn, NY | $75.25 | $15.27 – $194.32 | 92,680 | 22 |
| Christiansted, VI | $116.57 | $0.00 – $193.59 | 92,655 | 45 |
| Burlington, NJ | $51.29 | $0.00 – $131.50 | 92,646 | 47 |
| Cheverly, MD | $97.15 | $0.00 – $221.49 | 92,642 | 44 |
| Waukee, IA | $37.55 | $0.00 – $56.29 | 92,563 | 45 |
| Livingston, LA | $11.32 | $0.00 – $81.40 | 92,354 | 20 |
| Clay City, KY | $31.79 | $13.58 – $44.71 | 92,249 | 12 |
| Anderson, CA | $3.09 | $0.00 – $44.76 | 92,236 | 13 |
| Newport, OR | $79.47 | $0.00 – $279.03 | 92,207 | 70 |
| Seguin, TX | $49.94 | $0.00 – $184.53 | 92,173 | 56 |
| Wisconsin Rapids, WI | $37.87 | $0.00 – $72.74 | 92,149 | 63 |
| Independence, OH | $44.32 | $10.68 – $323.05 | 92,116 | 80 |
| Campbell, OH | $36.71 | $27.36 – $99.80 | 92,093 | 10 |
| Tallulah, LA | $5.01 | $0.00 – $63.90 | 92,039 | 16 |
| Barceloneta, PR | $5.44 | $0.00 – $71.35 | 92,030 | 30 |
| Jerseyville, IL | $2.84 | $0.00 – $74.13 | 91,998 | 22 |
| Menomonie, WI | $25.38 | $0.00 – $125.42 | 91,871 | 80 |
| Connellsville, PA | $33.25 | $0.00 – $127.23 | 91,800 | 30 |
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.