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 |
|---|---|---|---|---|
| Pismo Beach, CA | $72.84 | $0.00 – $320.20 | 72,394 | 32 |
| West Paterson, NJ | $49.57 | $3.59 – $84.46 | 72,314 | 13 |
| Harahan, LA | $29.93 | $2.40 – $96.79 | 72,282 | 11 |
| Dodge City, KS | $53.28 | $0.00 – $259.85 | 72,256 | 43 |
| Amite, LA | $13.67 | $0.00 – $45.86 | 72,241 | 23 |
| Lame Deer, MT | $1.41 | $0.00 – $65.38 | 72,234 | 3 |
| Camden, AR | $40.41 | $14.65 – $61.90 | 72,213 | 25 |
| Millsboro, DE | $56.57 | $0.00 – $394.15 | 72,179 | 37 |
| Piqua, OH | $61.29 | $19.52 – $129.84 | 72,157 | 40 |
| Shelby Twp, MI | $59.99 | $0.00 – $70.12 | 72,135 | 7 |
| Anaconda, MT | $58.07 | $0.00 – $161.81 | 72,125 | 38 |
| Glenview, IL | $49.35 | $4.08 – $110.51 | 72,116 | 116 |
| Centerville, IA | $17.81 | $0.00 – $66.02 | 72,030 | 24 |
| Mount Airy, MD | $71.11 | $0.00 – $120.29 | 72,027 | 21 |
| Euclid, OH | $38.27 | $9.62 – $95.37 | 72,015 | 64 |
| Ringgold, GA | $53.92 | $8.02 – $73.90 | 72,008 | 25 |
| Ridgefield, CT | $72.43 | $4.19 – $111.52 | 71,996 | 35 |
| Libby, MT | $5.52 | $0.00 – $92.50 | 71,945 | 12 |
| Pikeville, TN | $34.96 | $23.90 – $54.79 | 71,901 | 17 |
| Lewisburg, TN | $38.89 | $2.17 – $65.34 | 71,834 | 40 |
| Scottsburg, IN | $50.66 | $16.02 – $73.52 | 71,833 | 24 |
| Cottage Grove, OR | $66.25 | $16.24 – $147.64 | 71,794 | 27 |
| Jackson, GA | $49.10 | $0.00 – $75.87 | 71,779 | 9 |
| Jasper, TN | $41.03 | $8.80 – $64.84 | 71,642 | 20 |
| Southampton, NY | $83.93 | $0.00 – $184.64 | 71,633 | 45 |
| Fort Defiance, AZ | $56.83 | $0.00 – $673.30 | 71,620 | 79 |
| Emporia, VA | $44.50 | $12.90 – $97.04 | 71,597 | 19 |
| Highland Park, MI | $70.12 | $30.33 – $104.82 | 71,575 | 6 |
| Vivian, LA | $0.06 | $0.00 – $37.53 | 71,568 | 7 |
| Johnstown, CO | $65.44 | $21.39 – $87.73 | 71,418 | 35 |
| Evergreen, AL | $42.52 | $0.02 – $231.15 | 71,327 | 13 |
| Santa Rosa, NM | $18.77 | $2.88 – $143.90 | 71,175 | 10 |
| Petal, MS | $64.55 | $10.77 – $139.16 | 71,082 | 30 |
| Clanton, AL | $76.30 | $0.00 – $241.42 | 71,066 | 30 |
| Glen Oaks, NY | $76.16 | $0.52 – $186.28 | 71,023 | 72 |
| Barnwell, SC | $126.51 | $22.09 – $162.41 | 71,001 | 23 |
| Lexington, VA | $56.48 | $16.10 – $90.09 | 71,000 | 53 |
| Jellico, TN | $31.44 | $16.80 – $55.72 | 70,993 | 19 |
| Millburn, NJ | $49.78 | $0.00 – $171.39 | 70,934 | 51 |
| Dedham, MA | $54.41 | $4.61 – $149.12 | 70,924 | 59 |
| Warren, NJ | $35.14 | $7.75 – $179.12 | 70,910 | 41 |
| Saint Albans, WV | $24.07 | $0.00 – $97.88 | 70,847 | 20 |
| Leawood, KS | $48.83 | $0.00 – $305.47 | 70,725 | 48 |
| Highland, CA | $9.98 | $0.00 – $155.03 | 70,716 | 45 |
| Fair Oaks, CA | $8.23 | $0.00 – $81.61 | 70,554 | 27 |
| Edgewater, MD | $78.80 | $0.00 – $134.23 | 70,456 | 31 |
| San Andreas, CA | $38.53 | $0.00 – $1,276 | 70,413 | 18 |
| Woodstock, VA | $59.39 | $6.23 – $88.65 | 70,410 | 27 |
| Gillette, WY | $54.56 | $0.00 – $129.94 | 70,388 | 87 |
| Rock Hill, NY | $80.01 | $29.15 – $143.70 | 70,235 | 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.