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 |
|---|---|---|---|---|
| Cedar Hill, TX | $34.38 | $2.88 – $90.63 | 78,282 | 23 |
| Inwood, NY | $45.89 | $10.57 – $75.08 | 78,261 | 9 |
| Garfield Heights, OH | $60.22 | $7.57 – $110.68 | 78,211 | 40 |
| Kendallville, IN | $57.37 | $20.21 – $104.78 | 78,206 | 36 |
| Springhill, LA | $24.65 | $0.00 – $81.08 | 78,173 | 14 |
| Mitchell, SD | $66.87 | $16.24 – $123.28 | 78,153 | 21 |
| Holly Springs, NC | $56.45 | $4.67 – $99.47 | 78,149 | 57 |
| Piedmont, SC | $63.15 | $27.59 – $318.75 | 78,141 | 25 |
| Hainesport, NJ | $55.23 | $0.00 – $106.36 | 78,078 | 27 |
| Pullman, WA | $51.09 | $0.41 – $93.31 | 78,047 | 78 |
| Bad Axe, MI | $103.61 | $0.94 – $353.41 | 78,023 | 22 |
| Rutherfordton, NC | $51.35 | $7.76 – $113.14 | 77,998 | 29 |
| Middleburg Heights, OH | $40.35 | $13.02 – $263.48 | 77,995 | 81 |
| North Smithfield, RI | $45.31 | $0.01 – $93.57 | 77,960 | 30 |
| Talbott, TN | $46.68 | $25.55 – $58.25 | 77,915 | 17 |
| Whitehall, OH | $59.74 | $10.08 – $222.62 | 77,901 | 17 |
| Tujunga, CA | $31.23 | $0.15 – $80.35 | 77,882 | 9 |
| Pontiac, IL | $36.11 | $0.00 – $438.57 | 77,776 | 31 |
| Dunwoody, GA | $51.12 | $2.04 – $80.47 | 77,706 | 16 |
| Clarion, IA | $24.29 | $0.01 – $47.72 | 77,574 | 24 |
| Wynnewood, PA | $54.52 | $0.19 – $138.90 | 77,541 | 131 |
| De Pere, WI | $30.05 | $10.38 – $66.21 | 77,473 | 85 |
| Marion, KY | $29.50 | $9.59 – $42.85 | 77,408 | 19 |
| Bloomsburg, PA | $43.18 | $4.50 – $121.83 | 77,407 | 47 |
| Pendleton, OR | $59.58 | $1.30 – $514.12 | 77,366 | 52 |
| Carteret, NJ | $42.46 | $0.00 – $83.94 | 77,354 | 16 |
| Jenks, OK | $98.93 | $45.09 – $652.76 | 77,323 | 36 |
| Chestertown, MD | $82.12 | $0.00 – $201.13 | 77,291 | 50 |
| North Chelmsford, MA | $46.38 | $1.34 – $96.01 | 77,289 | 55 |
| Gray, LA | $26.67 | $0.02 – $57.51 | 77,263 | 19 |
| Amherst, OH | $44.54 | $19.06 – $81.15 | 77,250 | 26 |
| Beeville, TX | $25.98 | $3.82 – $85.37 | 77,197 | 21 |
| Stratford, NJ | $74.87 | $10.03 – $196.24 | 77,188 | 57 |
| Delran, NJ | $62.39 | $0.00 – $123.04 | 77,145 | 29 |
| Tualatin, OR | $73.35 | $3.03 – $281.39 | 77,133 | 115 |
| Boys Town, NE | $68.60 | $26.69 – $114.16 | 77,129 | 54 |
| Pineville, WV | $4.26 | $0.00 – $50.25 | 77,066 | 8 |
| Susanville, CA | $8.01 | $0.00 – $518.18 | 77,048 | 28 |
| West Branch, MI | $33.51 | $10.10 – $53.97 | 77,037 | 17 |
| Shoreline, WA | $42.98 | $0.62 – $216.76 | 77,020 | 76 |
| Weymouth, MA | $62.68 | $3.27 – $122.90 | 76,932 | 106 |
| Ponte Vedra, FL | $98.36 | $0.00 – $578.09 | 76,882 | 25 |
| Lititz, PA | $46.94 | $0.00 – $132.84 | 76,801 | 77 |
| South Chesterfield, VA | $52.68 | $8.16 – $65.18 | 76,708 | 11 |
| Stroudsburg, PA | $48.64 | $3.20 – $549.40 | 76,706 | 43 |
| Eagan, MN | $68.00 | $0.00 – $217.74 | 76,696 | 138 |
| Las Piedras, PR | $7.66 | $0.00 – $77.95 | 76,625 | 29 |
| Chowchilla, CA | $5.15 | $0.00 – $28.89 | 76,550 | 10 |
| Batavia, IL | $68.28 | $27.72 – $103.37 | 76,536 | 14 |
| Littleton, NH | $38.06 | $0.00 – $170.82 | 76,466 | 53 |
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.