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 |
|---|---|---|---|---|
| Dana Point, CA | $36.11 | $26.47 – $73.48 | 35,540 | 4 |
| Springville, UT | $64.33 | $41.53 – $89.21 | 35,517 | 27 |
| Frisco, CO | $111.80 | $0.00 – $674.23 | 35,485 | 35 |
| N Wilkesboro, NC | $65.02 | $18.74 – $68.85 | 35,484 | 7 |
| Forest Park, IL | $57.63 | $29.19 – $91.99 | 35,478 | 16 |
| Jefferson Hills, PA | $38.67 | $0.48 – $83.16 | 35,455 | 49 |
| Endwell, NY | $69.80 | $16.65 – $89.98 | 35,451 | 36 |
| Prentiss, MS | $45.10 | $4.47 – $97.59 | 35,449 | 16 |
| Mill Creek, WA | $67.21 | $0.78 – $115.03 | 35,444 | 38 |
| Portageville, MO | $58.68 | $19.75 – $174.13 | 35,420 | 8 |
| Aledo, IL | $2.47 | $0.07 – $54.42 | 35,418 | 8 |
| Lakewood, NY | $53.01 | $9.07 – $94.87 | 35,407 | 11 |
| Stonewall, LA | $16.83 | $0.00 – $33.99 | 35,394 | 5 |
| Wellington, KS | $49.26 | $0.00 – $78.63 | 35,392 | 17 |
| Plummer, ID | $13.82 | $2.61 – $49.27 | 35,373 | 11 |
| Basking Ridge, NJ | $51.46 | $1.83 – $239.35 | 35,369 | 21 |
| Candler, NC | $34.64 | $2.05 – $79.03 | 35,362 | 22 |
| Martinez, GA | $63.93 | $23.04 – $81.76 | 35,356 | 11 |
| Las Marias, PR | $0.86 | $0.00 – $21.32 | 35,322 | 7 |
| Halls, TN | $32.27 | $24.71 – $48.60 | 35,319 | 6 |
| Gardendale, AL | $47.12 | $0.00 – $201.64 | 35,314 | 19 |
| Patten, ME | $15.39 | $2.13 – $82.97 | 35,311 | 5 |
| Bartow, FL | $44.95 | $0.45 – $82.97 | 35,291 | 13 |
| Cudahy, WI | $38.34 | $16.08 – $70.01 | 35,267 | 27 |
| Lewistown, MT | $27.17 | $0.00 – $108.69 | 35,267 | 21 |
| Emeryville, CA | $34.60 | $0.00 – $135.98 | 35,255 | 45 |
| Stanwood, WA | $28.81 | $1.21 – $79.22 | 35,246 | 28 |
| Bradshaw, WV | $6.02 | $0.00 – $17.05 | 35,193 | 4 |
| Kensington, CT | $42.24 | $7.96 – $97.32 | 35,190 | 11 |
| Cheney, WA | $47.57 | $6.99 – $73.59 | 35,160 | 16 |
| Melville, NY | $92.07 | $0.00 – $178.53 | 35,145 | 29 |
| Caldwell, OH | $50.58 | $8.45 – $71.29 | 35,130 | 10 |
| Tenafly, NJ | $52.09 | $0.00 – $79.95 | 35,121 | 29 |
| Waterloo, NY | $87.51 | $52.34 – $141.34 | 35,117 | 14 |
| Keenesburg, CO | $64.49 | $63.15 – $64.67 | 35,082 | 2 |
| La Salle, IL | $15.95 | $0.00 – $109.06 | 35,067 | 6 |
| Monument, CO | $128.27 | $4.24 – $344.76 | 35,016 | 31 |
| Monticello, IL | $12.74 | $0.00 – $66.89 | 35,016 | 17 |
| Livingston, AL | $15.96 | $0.10 – $197.15 | 35,014 | 3 |
| Ceiba, PR | $0.61 | $0.00 – $14.00 | 34,992 | 7 |
| Mission, SD | $163.34 | $76.28 – $165.42 | 34,982 | 2 |
| Douglas, GA | $48.63 | $0.00 – $110.43 | 34,970 | 15 |
| Thomasville, AL | $20.39 | $0.00 – $71.94 | 34,968 | 14 |
| Bernice, LA | $3.98 | $0.00 – $43.66 | 34,958 | 4 |
| East Norriton, PA | $36.88 | $0.02 – $143.71 | 34,956 | 53 |
| Owatonna, MN | $87.57 | $15.63 – $249.91 | 34,940 | 69 |
| Whitestone, NY | $79.46 | $25.65 – $108.49 | 34,930 | 12 |
| Eaton Rapids, MI | $21.96 | $16.38 – $48.30 | 34,922 | 5 |
| Fallsburg, NY | $62.52 | $62.22 – $78.68 | 34,911 | 2 |
| South El Monte, CA | $18.40 | $0.00 – $43.05 | 34,909 | 7 |
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.