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 |
|---|---|---|---|---|
| Hingham, MA | $53.21 | $0.00 – $131.47 | 29,848 | 26 |
| Belton, MO | $60.77 | $27.45 – $127.56 | 29,848 | 21 |
| Burlington, CO | $158.11 | $0.00 – $198.16 | 29,840 | 10 |
| South Kingstown, RI | $61.31 | $37.29 – $112.09 | 29,834 | 17 |
| Seatac, WA | $43.20 | $18.08 – $70.39 | 29,817 | 19 |
| Cedar Lake, IN | $65.07 | $48.46 – $75.51 | 29,806 | 11 |
| Locust Grove, GA | $65.20 | $0.45 – $123.51 | 29,786 | 14 |
| Medford, NY | $92.06 | $4.89 – $200.13 | 29,784 | 26 |
| Imlay City, MI | $47.75 | $18.29 – $72.18 | 29,782 | 5 |
| Bethalto, IL | $49.09 | $34.65 – $77.98 | 29,782 | 15 |
| Enterprise, OR | $24.48 | $0.00 – $73.77 | 29,772 | 22 |
| Garnerville, NY | $93.87 | $12.07 – $156.72 | 29,771 | 15 |
| Prudenville, MI | $16.20 | $3.09 – $70.28 | 29,752 | 3 |
| Woodridge, VA | $59.35 | $59.35 – $59.35 | 29,748 | 1 |
| Frederick, CO | $114.18 | $40.82 – $181.18 | 29,746 | 8 |
| Byhalia, MS | $54.27 | $8.23 – $88.61 | 29,741 | 19 |
| Rockaway Park, NY | $63.98 | $17.66 – $137.15 | 29,735 | 12 |
| Pearisburg, VA | $60.48 | $11.08 – $95.80 | 29,731 | 18 |
| Wantagh, NY | $87.79 | $5.65 – $141.17 | 29,727 | 20 |
| Wahpeton, ND | $72.53 | $53.24 – $132.52 | 29,722 | 28 |
| San Bernadino, CA | $85.27 | $85.27 – $85.27 | 29,695 | 1 |
| Apollo Beach, FL | $62.14 | $15.60 – $69.99 | 29,690 | 9 |
| Woodhaven, MI | $69.93 | $0.00 – $101.43 | 29,669 | 6 |
| Center, TX | $33.19 | $13.73 – $57.15 | 29,664 | 13 |
| Washington Township, MI | $73.32 | $51.39 – $99.38 | 29,661 | 4 |
| Jensen Beach, FL | $46.71 | $0.00 – $308.77 | 29,630 | 22 |
| Butner, NC | $61.27 | $50.82 – $101.87 | 29,629 | 11 |
| Evanston, WY | $45.20 | $0.00 – $70.76 | 29,628 | 21 |
| Hanover, MA | $55.64 | $0.21 – $91.61 | 29,624 | 25 |
| Ashburn, GA | $101.21 | $29.49 – $110.99 | 29,624 | 4 |
| Englewood, TN | $25.92 | $7.58 – $37.64 | 29,610 | 7 |
| Hamburg, NJ | $47.81 | $26.80 – $50.23 | 29,603 | 4 |
| El Segundo, CA | $25.92 | $0.00 – $242.14 | 29,600 | 34 |
| Warsaw, NY | $71.06 | $25.05 – $122.38 | 29,585 | 26 |
| Morgan Hill, CA | $86.44 | $0.00 – $1,568 | 29,574 | 23 |
| Trezevant, TN | $39.91 | $37.68 – $40.31 | 29,565 | 3 |
| Rainsville, AL | $40.25 | $4.57 – $77.73 | 29,563 | 22 |
| Signal Hill, CA | $9.54 | $0.85 – $36.65 | 29,561 | 7 |
| Medford, NJ | $72.15 | $0.00 – $204.22 | 29,546 | 50 |
| Franklin, PA | $45.62 | $0.00 – $77.89 | 29,535 | 29 |
| Havelock, NC | $55.85 | $20.78 – $82.44 | 29,521 | 17 |
| Manchester, PA | $51.65 | $1.05 – $97.96 | 29,515 | 20 |
| Tinton Falls, NJ | $35.15 | $2.38 – $76.43 | 29,505 | 28 |
| Parkersburg, IA | $26.60 | $0.08 – $59.15 | 29,479 | 13 |
| Bonne Terre, MO | $56.14 | $7.93 – $73.64 | 29,456 | 13 |
| Live Oak, FL | $25.22 | $2.42 – $65.16 | 29,455 | 29 |
| Tazewell, VA | $57.71 | $15.35 – $80.70 | 29,428 | 17 |
| River Falls, WI | $30.41 | $10.88 – $160.22 | 29,428 | 31 |
| West Haverstraw, NY | $69.00 | $56.67 – $85.30 | 29,424 | 4 |
| Winter Springs, FL | $69.37 | $9.79 – $155.98 | 29,391 | 12 |
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.