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 |
|---|---|---|---|---|
| Bay St Louis, MS | $52.75 | $1.10 – $105.39 | 55,914 | 37 |
| Orange, NJ | $44.76 | $1.58 – $102.24 | 55,912 | 20 |
| Grafton, WV | $21.95 | $0.00 – $78.32 | 55,901 | 21 |
| Bay Minette, AL | $60.95 | $0.00 – $90.23 | 55,901 | 32 |
| Liberty Twp, OH | $51.88 | $17.92 – $65.43 | 55,847 | 16 |
| Fredericktown, PA | $0.08 | $0.00 – $11.82 | 55,842 | 6 |
| Cankton, LA | $2.83 | $0.00 – $6.27 | 55,822 | 6 |
| Onley, VA | $60.38 | $9.96 – $127.66 | 55,821 | 21 |
| Princeton, NJ | $56.28 | $0.00 – $187.97 | 55,812 | 71 |
| Celebration, FL | $53.85 | $0.00 – $563.14 | 55,808 | 71 |
| Painted Post, NY | $73.70 | $0.00 – $114.42 | 55,789 | 12 |
| Guilford, CT | $45.74 | $0.00 – $96.00 | 55,789 | 76 |
| Anthem, AZ | $78.16 | $16.74 – $124.52 | 55,772 | 32 |
| Taylorsville, UT | $60.98 | $0.00 – $128.22 | 55,767 | 42 |
| Menasha, WI | $23.82 | $10.19 – $114.04 | 55,704 | 50 |
| Pittston, PA | $41.92 | $11.98 – $106.93 | 55,650 | 25 |
| Wiggins, MS | $61.67 | $4.84 – $104.27 | 55,616 | 20 |
| Carol Stream, IL | $44.05 | $0.00 – $124.42 | 55,614 | 31 |
| Moorefield, WV | $9.11 | $0.00 – $52.28 | 55,567 | 19 |
| Brownsburg, IN | $57.35 | $4.63 – $121.33 | 55,538 | 54 |
| Salem, NJ | $25.11 | $0.16 – $97.71 | 55,534 | 12 |
| American Fork, UT | $50.69 | $0.00 – $127.30 | 55,529 | 73 |
| Rutherford, NJ | $53.24 | $2.01 – $150.83 | 55,451 | 39 |
| Pocahontas, AR | $32.16 | $0.00 – $43.40 | 55,444 | 25 |
| Amery, WI | $47.40 | $7.50 – $302.80 | 55,430 | 40 |
| Detroit Lakes, MN | $72.29 | $26.60 – $203.01 | 55,422 | 72 |
| Thermal, CA | $5.44 | $0.43 – $32.07 | 55,240 | 8 |
| Pawleys Island, SC | $66.08 | $5.27 – $106.88 | 55,227 | 36 |
| Somerville, NJ | $46.01 | $0.00 – $131.96 | 55,224 | 47 |
| Okatie, SC | $89.49 | $2.68 – $250.27 | 55,216 | 25 |
| Watertown, WI | $36.05 | $0.00 – $71.81 | 55,192 | 48 |
| Midvale, UT | $74.36 | $16.30 – $214.46 | 55,177 | 23 |
| Lander, WY | $42.13 | $0.00 – $83.55 | 55,176 | 55 |
| Douglasville, GA | $54.34 | $0.00 – $131.05 | 55,128 | 37 |
| Springvale, ME | $3.83 | $0.00 – $63.35 | 55,097 | 8 |
| Deltona, FL | $42.75 | $0.00 – $123.71 | 55,073 | 45 |
| Gouverneur, NY | $86.80 | $2.77 – $171.89 | 55,059 | 13 |
| Canby, OR | $72.42 | $24.21 – $152.89 | 55,021 | 30 |
| Morton, IL | $53.98 | $5.87 – $81.18 | 55,017 | 34 |
| Randolph, MA | $56.21 | $5.12 – $122.28 | 55,015 | 30 |
| Aguas Buenas, PR | $1.09 | $0.00 – $6.08 | 55,009 | 15 |
| Irvington, AL | $4.02 | $0.00 – $42.21 | 54,960 | 17 |
| Stow, OH | $37.29 | $17.63 – $100.46 | 54,890 | 49 |
| Albion, NY | $65.17 | $28.37 – $148.67 | 54,890 | 15 |
| Hamilton, AL | $25.81 | $0.00 – $225.27 | 54,888 | 20 |
| Quakertown, PA | $50.11 | $1.87 – $132.84 | 54,882 | 60 |
| Mukilteo, WA | $57.79 | $1.11 – $99.77 | 54,880 | 40 |
| Waycross, GA | $52.41 | $5.78 – $107.84 | 54,848 | 28 |
| Oradell, NJ | $42.51 | $8.66 – $70.12 | 54,841 | 12 |
| Holbrook, NY | $113.42 | $36.34 – $165.01 | 54,815 | 25 |
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.