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 |
|---|---|---|---|---|
| Pittsfield, IL | $3.18 | $0.00 – $53.38 | 82,845 | 12 |
| Newport, AR | $36.67 | $0.00 – $135.09 | 82,814 | 27 |
| Jenkintown, PA | $50.63 | $5.76 – $102.05 | 82,789 | 48 |
| Honesdale, PA | $15.53 | $0.00 – $88.05 | 82,755 | 43 |
| Crittenden, KY | $38.63 | $18.88 – $47.40 | 82,746 | 14 |
| Conway, NH | $20.10 | $0.00 – $66.05 | 82,735 | 23 |
| Knightdale, NC | $59.69 | $8.65 – $502.38 | 82,720 | 55 |
| Mequon, WI | $37.82 | $0.00 – $89.65 | 82,716 | 90 |
| Blue Hill, ME | $9.65 | $3.83 – $175.40 | 82,662 | 12 |
| Onalaska, WI | $30.50 | $5.12 – $92.83 | 82,591 | 117 |
| Morris, IL | $46.28 | $11.68 – $128.23 | 82,525 | 66 |
| Milledgeville, GA | $66.72 | $2.34 – $123.02 | 82,489 | 22 |
| Montclair, NJ | $49.62 | $0.00 – $244.71 | 82,471 | 56 |
| Newberry, SC | $114.57 | $0.09 – $239.60 | 82,466 | 31 |
| Indianola, MS | $67.71 | $0.00 – $185.26 | 82,294 | 21 |
| Fairfield, IL | $2.85 | $0.00 – $57.43 | 82,275 | 12 |
| Galt, CA | $4.14 | $1.22 – $59.56 | 82,212 | 7 |
| Orange, TX | $46.22 | $0.00 – $103.18 | 82,208 | 16 |
| Vonore, TN | $35.45 | $21.48 – $42.70 | 82,200 | 13 |
| Saint Petersburg, FL | $53.41 | $0.00 – $227.10 | 82,138 | 86 |
| Alpharetta, GA | $58.29 | $0.12 – $481.71 | 82,133 | 63 |
| Edenton, NC | $55.63 | $16.35 – $758.67 | 82,114 | 37 |
| Columbia, MS | $68.87 | $0.00 – $571.41 | 82,075 | 32 |
| Chester, PA | $32.58 | $0.00 – $151.57 | 82,055 | 77 |
| Coppell, TX | $47.12 | $0.00 – $546.04 | 82,032 | 36 |
| South Euclid, OH | $48.92 | $0.00 – $82.09 | 82,024 | 50 |
| Saint George, UT | $55.72 | $0.00 – $177.85 | 82,002 | 37 |
| Cadiz, KY | $27.40 | $13.99 – $38.48 | 81,954 | 27 |
| Southbury, CT | $46.23 | $0.00 – $116.92 | 81,927 | 64 |
| Celina, OH | $45.87 | $6.51 – $94.78 | 81,770 | 46 |
| Roswell, GA | $44.71 | $0.22 – $158.94 | 81,706 | 49 |
| Maryville, IL | $48.74 | $0.00 – $100.43 | 81,596 | 59 |
| Monticello, MS | $71.02 | $5.57 – $104.89 | 81,507 | 22 |
| Fort Bragg, NC | $71.98 | $0.00 – $936.32 | 81,491 | 69 |
| Willits, CA | $12.24 | $0.16 – $237.28 | 81,461 | 22 |
| Creston, IA | $32.53 | $0.00 – $127.02 | 81,405 | 47 |
| Buffalo Grove, IL | $50.83 | $0.95 – $121.49 | 81,381 | 51 |
| Cutler Bay, FL | $30.08 | $0.59 – $158.31 | 81,375 | 57 |
| West Miami, FL | $55.83 | $3.44 – $110.01 | 81,278 | 10 |
| Canton, GA | $70.80 | $18.52 – $124.55 | 81,253 | 35 |
| Camillus, NY | $74.12 | $0.00 – $116.83 | 81,208 | 69 |
| El Dorado Hills, CA | $38.34 | $0.00 – $222.76 | 81,208 | 21 |
| St Charles, IL | $56.98 | $8.79 – $106.23 | 81,193 | 61 |
| Port Gibson, MS | $54.24 | $0.00 – $98.70 | 81,128 | 15 |
| Okeechobee, FL | $37.77 | $0.00 – $71.96 | 81,119 | 47 |
| Palmetto Bay, FL | $52.13 | $0.42 – $176.80 | 81,098 | 40 |
| Morton Grove, IL | $53.43 | $2.21 – $95.97 | 80,987 | 44 |
| Caro, MI | $74.13 | $8.83 – $160.45 | 80,936 | 23 |
| Radford, VA | $58.77 | $0.30 – $77.53 | 80,916 | 34 |
| Niles, IL | $40.33 | $0.01 – $235.84 | 80,874 | 46 |
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.