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 |
|---|---|---|---|---|
| Reedley, CA | $4.20 | $0.00 – $503.63 | 656,026 | 67 |
| Meridian, MS | $55.92 | $0.00 – $198.14 | 655,208 | 290 |
| Pontiac, MI | $38.84 | $0.00 – $148.24 | 654,326 | 70 |
| Fairfax, VA | $56.44 | $0.00 – $196.01 | 654,102 | 624 |
| Dublin, OH | $59.23 | $0.00 – $308.68 | 653,569 | 379 |
| Newark, OH | $57.00 | $0.00 – $122.95 | 653,564 | 213 |
| Spring Valley, NY | $54.40 | $0.00 – $188.38 | 652,482 | 55 |
| Mansfield, OH | $44.35 | $0.00 – $122.59 | 651,257 | 255 |
| Annapolis, MD | $66.39 | $0.00 – $318.75 | 650,839 | 407 |
| Joplin, MO | $52.72 | $0.00 – $185.37 | 650,502 | 389 |
| Arlington, TX | $36.54 | $0.00 – $307.23 | 648,394 | 260 |
| Winchester, VA | $50.11 | $0.00 – $181.77 | 648,385 | 427 |
| Joliet, IL | $40.78 | $0.00 – $281.10 | 646,813 | 215 |
| Hopkinsville, KY | $37.12 | $0.00 – $220.32 | 639,100 | 161 |
| Saint Paul, MN | $86.72 | $0.00 – $680.54 | 635,726 | 927 |
| Middletown, CT | $37.60 | $0.00 – $272.46 | 635,282 | 317 |
| Roseville, CA | $30.38 | $0.00 – $765.17 | 633,678 | 404 |
| Harlingen, TX | $30.32 | $0.00 – $954.81 | 632,837 | 213 |
| Avondale, AZ | $51.88 | $0.00 – $124.41 | 632,662 | 156 |
| Chapel Hill, NC | $69.92 | $0.00 – $288.53 | 632,260 | 813 |
| Temple, TX | $50.86 | $0.00 – $220.75 | 631,120 | 444 |
| Marion, OH | $46.68 | $0.00 – $149.93 | 630,352 | 195 |
| Battle Creek, MI | $36.75 | $3.98 – $96.28 | 629,996 | 61 |
| Farmington, NM | $93.15 | $0.00 – $524.49 | 627,708 | 221 |
| Oak Lawn, IL | $52.92 | $0.00 – $201.00 | 627,482 | 374 |
| Ada, OK | $292.61 | $0.12 – $719.00 | 627,087 | 278 |
| Merrillville, IN | $54.67 | $0.00 – $139.52 | 626,977 | 205 |
| Pittsfield, MA | $73.14 | $1.26 – $191.03 | 623,777 | 259 |
| Greenbelt, MD | $71.25 | $0.00 – $289.24 | 622,261 | 218 |
| Wyoming, MI | $47.09 | $0.00 – $86.85 | 621,928 | 37 |
| Santa Fe, NM | $93.59 | $0.00 – $578.77 | 620,520 | 370 |
| Columbia, TN | $37.81 | $0.00 – $85.89 | 620,420 | 213 |
| Princeton, WV | $44.35 | $0.00 – $98.01 | 619,780 | 136 |
| Parkersburg, WV | $57.17 | $0.00 – $127.81 | 618,445 | 209 |
| Palm Springs, CA | $46.09 | $0.00 – $709.00 | 617,773 | 206 |
| Bellingham, WA | $52.34 | $0.00 – $269.34 | 616,251 | 506 |
| Gallipolis, OH | $43.81 | $0.00 – $96.22 | 613,861 | 153 |
| Missoula, MT | $66.97 | $0.00 – $658.37 | 613,504 | 431 |
| Athens, OH | $49.39 | $0.00 – $115.76 | 611,668 | 206 |
| Erie, PA | $43.85 | $0.00 – $207.19 | 611,163 | 475 |
| Hickory, NC | $54.64 | $0.50 – $152.81 | 610,478 | 360 |
| Lancaster, PA | $39.75 | $0.00 – $265.97 | 607,480 | 496 |
| East Boston, MA | $35.86 | $0.00 – $165.49 | 606,020 | 143 |
| Indio, CA | $26.36 | $0.00 – $1,501 | 603,895 | 98 |
| Hamilton, OH | $46.10 | $0.52 – $163.58 | 600,395 | 191 |
| Richmond, IN | $54.50 | $4.84 – $311.46 | 598,718 | 237 |
| Kokomo, IN | $57.56 | $1.80 – $115.64 | 596,793 | 233 |
| Spokane Valley, WA | $56.34 | $2.44 – $183.14 | 596,563 | 312 |
| Liverpool, NY | $81.33 | $0.00 – $193.48 | 595,000 | 162 |
| Portland, ME | $36.14 | $0.00 – $138.35 | 593,977 | 640 |
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.