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 |
|---|---|---|---|---|
| Farmington, WV | $24.66 | $12.01 – $31.91 | 87,328 | 2 |
| Vernal, UT | $72.53 | $27.04 – $237.48 | 87,298 | 41 |
| Haleyville, AL | $34.47 | $0.00 – $77.13 | 87,269 | 26 |
| Jayuya, PR | $0.85 | $0.00 – $58.18 | 87,207 | 20 |
| Camden On Gauley, WV | $15.13 | $0.00 – $57.94 | 87,105 | 20 |
| Mckinleyville, CA | $12.42 | $0.00 – $82.58 | 87,078 | 21 |
| Bristol, VA | $51.55 | $4.32 – $89.94 | 87,025 | 34 |
| Rhinelander, WI | $38.85 | $0.00 – $71.78 | 86,998 | 73 |
| Rocklin, CA | $17.86 | $0.00 – $1,107 | 86,952 | 28 |
| El Reno, OK | $93.69 | $47.61 – $669.56 | 86,934 | 27 |
| Clark, NJ | $67.67 | $3.93 – $126.92 | 86,793 | 43 |
| Eatontown, NJ | $57.20 | $0.00 – $236.90 | 86,745 | 55 |
| Happy Valley, OR | $77.90 | $9.23 – $192.25 | 86,733 | 56 |
| Lewisburg, PA | $41.79 | $0.00 – $102.99 | 86,689 | 67 |
| South Orange, NJ | $43.53 | $2.62 – $119.43 | 86,688 | 24 |
| W. Sacramento, CA | $0.20 | $0.20 – $0.20 | 86,576 | 1 |
| Orem, UT | $67.17 | $0.00 – $112.82 | 86,502 | 90 |
| Camden, SC | $60.68 | $9.36 – $137.27 | 86,499 | 39 |
| Westbrook, ME | $38.72 | $0.00 – $81.53 | 86,455 | 74 |
| Saint Martinville, LA | $2.82 | $0.00 – $50.50 | 86,412 | 11 |
| Sherwood, AR | $45.96 | $4.07 – $88.80 | 86,409 | 24 |
| Vandalia, IL | $11.00 | $0.00 – $58.98 | 86,298 | 18 |
| Clifton Park, NY | $65.60 | $32.83 – $133.50 | 86,287 | 74 |
| Ramona, CA | $2.34 | $0.00 – $636.06 | 86,227 | 15 |
| Kahului, HI | $61.30 | $0.00 – $325.07 | 86,218 | 45 |
| Georgetown, TX | $32.79 | $0.00 – $117.06 | 85,993 | 76 |
| Claremont, NH | $36.57 | $0.00 – $185.33 | 85,956 | 46 |
| Commerce City, CO | $103.84 | $0.82 – $183.04 | 85,844 | 41 |
| Lewiston, NY | $57.41 | $6.91 – $117.64 | 85,841 | 41 |
| Rowland Heights, CA | $14.63 | $0.00 – $102.22 | 85,812 | 45 |
| Fairborn, OH | $71.10 | $9.67 – $318.75 | 85,748 | 40 |
| Central Islip, NY | $71.10 | $0.00 – $152.45 | 85,605 | 20 |
| Ridgecrest, CA | $21.13 | $0.00 – $352.67 | 85,588 | 67 |
| Blue Springs, MO | $68.71 | $0.00 – $182.81 | 85,544 | 51 |
| Burlington, WI | $33.95 | $0.00 – $68.44 | 85,505 | 86 |
| Emporia, KS | $115.97 | $0.00 – $182.44 | 85,418 | 48 |
| South Holland, IL | $43.09 | $0.00 – $234.53 | 85,408 | 38 |
| Gautier, MS | $24.38 | $0.00 – $87.50 | 85,384 | 13 |
| West Bridgewater, MA | $42.03 | $0.00 – $70.88 | 85,374 | 17 |
| Mamou, LA | $21.85 | $0.00 – $56.64 | 85,360 | 14 |
| Allegan, MI | $38.55 | $1.36 – $193.01 | 85,347 | 9 |
| Turnersville, NJ | $46.96 | $0.00 – $150.96 | 85,338 | 63 |
| Pennington Gap, VA | $57.45 | $9.79 – $398.45 | 85,306 | 13 |
| Bingham Farms, MI | $68.72 | $4.88 – $156.83 | 85,247 | 21 |
| Sparta, NJ | $58.72 | $0.00 – $92.13 | 85,200 | 33 |
| Manhattan Beach, CA | $5.07 | $0.00 – $174.91 | 85,114 | 34 |
| Flatwoods, KY | $31.41 | $10.74 – $43.80 | 85,093 | 17 |
| Port Barre, LA | $6.56 | $0.00 – $39.75 | 85,083 | 10 |
| Milpitas, CA | $7.53 | $0.00 – $176.40 | 85,063 | 62 |
| St Johnsbury, VT | $14.72 | $0.00 – $316.61 | 84,989 | 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.