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 |
|---|---|---|---|---|
| Allentown, PA | $49.53 | $0.00 – $196.33 | 843,711 | 705 |
| Opelousas, LA | $32.59 | $0.00 – $77.29 | 842,456 | 156 |
| Columbia, MO | $69.02 | $0.00 – $357.14 | 841,267 | 789 |
| Ocala, FL | $42.27 | $0.00 – $489.92 | 840,243 | 401 |
| Fort Collins, CO | $82.71 | $0.00 – $526.71 | 834,808 | 596 |
| Huntsville, AL | $54.21 | $0.00 – $1,976 | 834,714 | 556 |
| Binghamton, NY | $100.30 | $0.34 – $267.15 | 833,952 | 238 |
| Jackson, MI | $57.59 | $0.00 – $307.47 | 830,886 | 108 |
| Apple Valley, CA | $35.98 | $0.00 – $916.44 | 830,221 | 181 |
| Glen Burnie, MD | $87.59 | $0.00 – $605.19 | 830,008 | 336 |
| Oceanside, CA | $21.55 | $0.00 – $2,212 | 826,862 | 203 |
| Clarksville, TN | $38.93 | $0.00 – $241.51 | 826,270 | 311 |
| Woodbridge, VA | $64.89 | $0.00 – $260.34 | 823,646 | 299 |
| Concord, NC | $62.25 | $0.00 – $200.77 | 822,550 | 507 |
| Jonesboro, AR | $37.92 | $0.00 – $651.95 | 821,732 | 441 |
| French Camp, CA | $11.01 | $0.00 – $346.35 | 820,929 | 107 |
| Lumberton, NC | $51.56 | $0.00 – $116.83 | 820,249 | 226 |
| Tupelo, MS | $50.43 | $0.00 – $342.24 | 816,557 | 430 |
| Anderson, IN | $55.18 | $3.65 – $296.15 | 815,544 | 282 |
| Springfield, OH | $42.86 | $0.00 – $142.34 | 811,367 | 278 |
| Chesapeake, VA | $57.44 | $0.00 – $124.31 | 810,997 | 471 |
| Watsonville, CA | $23.13 | $0.00 – $177.38 | 810,071 | 105 |
| Burbank, CA | $13.24 | $0.00 – $272.38 | 807,132 | 311 |
| Gulfport, MS | $41.92 | $0.00 – $445.25 | 805,549 | 317 |
| Danbury, CT | $41.20 | $0.00 – $179.84 | 799,781 | 440 |
| Louisa, KY | $26.43 | $14.83 – $65.80 | 798,312 | 73 |
| Farmington, CT | $45.96 | $0.00 – $315.09 | 797,879 | 555 |
| Rancho Cucamonga, CA | $34.97 | $0.00 – $994.00 | 796,693 | 194 |
| Elgin, IL | $16.29 | $0.00 – $122.80 | 796,669 | 206 |
| Lakeland, FL | $48.57 | $0.00 – $318.75 | 789,264 | 427 |
| South Bend, IN | $58.29 | $0.00 – $182.45 | 778,111 | 448 |
| Tulare, CA | $8.83 | $0.00 – $811.67 | 776,121 | 84 |
| Monroe, NY | $68.69 | $5.23 – $159.58 | 774,047 | 81 |
| Cleveland, TN | $35.43 | $0.00 – $75.26 | 771,865 | 204 |
| Billings, MT | $76.66 | $0.00 – $528.57 | 769,144 | 511 |
| Pensacola, FL | $44.16 | $0.00 – $1,535 | 768,378 | 689 |
| Manati, PR | $25.46 | $0.00 – $132.41 | 767,236 | 217 |
| Toms River, NJ | $39.86 | $0.00 – $233.31 | 767,181 | 264 |
| Green Bay, WI | $38.55 | $0.00 – $426.43 | 766,749 | 722 |
| Morehead, KY | $32.41 | $5.84 – $76.71 | 764,621 | 149 |
| Danville, VA | $42.81 | $0.71 – $375.97 | 763,706 | 202 |
| Frederick, MD | $90.91 | $0.00 – $319.84 | 760,250 | 472 |
| Pharr, TX | $33.77 | $0.00 – $695.76 | 758,543 | 57 |
| Goldsboro, NC | $52.64 | $0.00 – $302.49 | 755,846 | 231 |
| Edison, NJ | $46.03 | $1.38 – $189.29 | 753,071 | 266 |
| Muncie, IN | $58.81 | $0.00 – $462.66 | 752,762 | 342 |
| Anderson, SC | $61.81 | $4.25 – $171.78 | 750,373 | 307 |
| Sioux City, IA | $30.79 | $0.00 – $310.09 | 749,417 | 273 |
| National City, CA | $22.17 | $0.00 – $137.25 | 747,320 | 137 |
| Surprise, AZ | $49.61 | $0.00 – $170.23 | 746,261 | 217 |
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.