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 |
|---|---|---|---|---|
| Weslaco, TX | $34.65 | $0.00 – $587.82 | 978,963 | 110 |
| Fort Myers, FL | $58.85 | $0.00 – $509.56 | 977,258 | 818 |
| Jackson Heights, NY | $47.08 | $0.00 – $177.49 | 977,226 | 196 |
| Paducah, KY | $34.56 | $0.00 – $100.67 | 974,680 | 388 |
| Escondido, CA | $15.11 | $0.00 – $821.20 | 974,226 | 230 |
| Stamford, CT | $52.40 | $0.00 – $318.75 | 973,378 | 471 |
| Eugene, OR | $55.46 | $0.00 – $702.71 | 968,932 | 667 |
| New Hyde Park, NY | $99.67 | $0.00 – $256.57 | 957,044 | 623 |
| Astoria, NY | $62.06 | $0.00 – $164.64 | 954,531 | 258 |
| Martinez, CA | $6.96 | $0.00 – $682.00 | 951,501 | 251 |
| Yuba City, CA | $18.83 | $0.00 – $940.30 | 951,241 | 213 |
| Sioux Falls, SD | $50.32 | $0.00 – $687.82 | 948,639 | 260 |
| Passaic, NJ | $54.64 | $0.00 – $198.98 | 944,779 | 85 |
| Turlock, CA | $36.68 | $0.00 – $239.96 | 939,601 | 140 |
| Plantation, FL | $38.05 | $0.00 – $336.45 | 939,594 | 284 |
| Monterey Park, CA | $20.38 | $0.00 – $180.79 | 938,513 | 231 |
| Salisbury, MD | $95.91 | $0.00 – $201.72 | 938,156 | 461 |
| Richmond Hill, NY | $86.08 | $0.00 – $238.74 | 932,566 | 96 |
| Medford, OR | $66.56 | $0.00 – $507.65 | 929,668 | 665 |
| Royal Oak, MI | $57.00 | $0.00 – $582.92 | 928,728 | 80 |
| Corbin, KY | $34.72 | $4.00 – $74.88 | 928,039 | 201 |
| Peoria, AZ | $49.35 | $0.05 – $138.74 | 924,450 | 395 |
| Muskegon, MI | $36.29 | $0.00 – $453.84 | 923,796 | 80 |
| Kissimmee, FL | $44.40 | $0.00 – $441.35 | 923,195 | 421 |
| Gastonia, NC | $55.63 | $0.00 – $250.92 | 914,198 | 433 |
| Marrero, LA | $34.57 | $0.00 – $86.86 | 913,786 | 229 |
| Everett, WA | $50.78 | $0.00 – $597.88 | 902,482 | 718 |
| Alexandria, VA | $60.60 | $0.00 – $378.90 | 891,595 | 480 |
| Prestonsburg, KY | $36.84 | $14.03 – $64.60 | 889,997 | 146 |
| Farmington Hills, MI | $65.41 | $3.95 – $117.49 | 889,020 | 88 |
| Gainesville, FL | $44.68 | $0.00 – $665.35 | 885,779 | 906 |
| Dothan, AL | $64.38 | $0.00 – $1,617 | 884,011 | 349 |
| Gretna, LA | $39.19 | $0.00 – $217.02 | 883,314 | 132 |
| Lincoln, NE | $65.24 | $4.16 – $318.75 | 876,881 | 833 |
| Lynchburg, VA | $57.93 | $0.00 – $237.73 | 876,061 | 432 |
| New Brunswick, NJ | $97.34 | $0.00 – $447.88 | 870,025 | 470 |
| Glasgow, KY | $35.93 | $0.00 – $61.14 | 869,720 | 155 |
| St Petersburg, FL | $62.02 | $0.00 – $560.53 | 868,398 | 548 |
| San Marcos, CA | $9.71 | $0.00 – $174.91 | 866,422 | 160 |
| Newport News, VA | $58.44 | $0.00 – $149.96 | 865,138 | 546 |
| Vista, CA | $12.75 | $0.00 – $303.23 | 864,801 | 215 |
| Palo Alto, CA | $43.09 | $0.00 – $276.92 | 860,500 | 710 |
| Sterling Heights, MI | $64.34 | $0.00 – $124.13 | 859,446 | 112 |
| Chico, CA | $32.61 | $0.00 – $1,119 | 858,129 | 202 |
| Rego Park, NY | $61.05 | $0.00 – $173.39 | 856,990 | 183 |
| West Palm Beach, FL | $55.55 | $0.00 – $601.97 | 852,549 | 348 |
| Aurora, IL | $34.46 | $0.00 – $269.79 | 849,771 | 318 |
| Middletown, NY | $89.34 | $0.53 – $193.97 | 849,019 | 467 |
| New Iberia, LA | $36.26 | $0.00 – $76.21 | 846,442 | 137 |
| Morristown, TN | $36.90 | $2.47 – $82.16 | 844,836 | 201 |
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.