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 |
|---|---|---|---|---|
| Norwood, NC | $54.30 | $52.05 – $58.94 | 3,901 | 2 |
| Schofield, WI | $33.62 | $5.48 – $47.95 | 3,904 | 6 |
| Rockledge, PA | $48.65 | $8.21 – $78.29 | 3,909 | 7 |
| Crete, IL | $29.72 | $29.72 – $29.72 | 3,909 | 1 |
| Fort Moore, GA | $56.57 | $53.20 – $61.68 | 3,910 | 4 |
| Fairfax, VT | $23.39 | $0.03 – $104.76 | 3,913 | 7 |
| Turners Falls, MA | $46.26 | $28.06 – $60.81 | 3,918 | 8 |
| Albion, PA | $40.62 | $35.57 – $64.13 | 3,922 | 4 |
| Moundsvillle, WV | $57.89 | $57.89 – $57.89 | 3,922 | 1 |
| Oil City, LA | $32.63 | $29.04 – $33.78 | 3,924 | 2 |
| Friendship, TN | $48.94 | $39.18 – $51.85 | 3,925 | 2 |
| Calmar, IA | $33.36 | $26.82 – $35.84 | 3,926 | 3 |
| Reeds Spring, MO | $16.73 | $16.73 – $16.73 | 3,928 | 1 |
| Harrisville, UT | $58.75 | $4.59 – $75.74 | 3,930 | 4 |
| Livermore, KY | $39.33 | $39.33 – $39.33 | 3,931 | 1 |
| Hartford, VT | $14.70 | $1.65 – $38.54 | 3,932 | 6 |
| Oak Island, NC | $61.47 | $47.38 – $65.80 | 3,932 | 7 |
| Grainte, OK | $54.35 | $54.35 – $54.35 | 3,932 | 1 |
| Marblehead, MA | $55.36 | $0.00 – $78.42 | 3,935 | 16 |
| Seymour, WI | $32.01 | $20.35 – $65.21 | 3,938 | 7 |
| Spring Valley, MN | $61.34 | $56.42 – $61.71 | 3,939 | 2 |
| Hyndman, PA | $13.29 | $0.00 – $49.98 | 3,939 | 8 |
| Marion, NY | $74.44 | $39.98 – $93.17 | 3,940 | 6 |
| Grandview, MO | $65.17 | $12.40 – $76.91 | 3,944 | 7 |
| Duvall, WA | $51.36 | $45.71 – $56.08 | 3,946 | 6 |
| Pinetop, AZ | $55.77 | $55.77 – $55.77 | 3,947 | 1 |
| Plumsteadville, PA | $35.73 | $33.15 – $36.94 | 3,948 | 4 |
| Windsor Locks, CT | $50.00 | $27.95 – $51.30 | 3,950 | 3 |
| Oakville, CT | $20.96 | $0.63 – $55.53 | 3,955 | 3 |
| Greenup, IL | $6.01 | $0.00 – $23.36 | 3,956 | 2 |
| Beaver, OK | $135.24 | $107.46 – $217.20 | 3,957 | 7 |
| Miller, SD | $232.10 | $12.12 – $392.02 | 3,958 | 3 |
| Cornwall On Hudson, NY | $101.95 | $101.95 – $101.95 | 3,959 | 1 |
| Clay City, IN | $52.22 | $51.26 – $55.41 | 3,960 | 2 |
| Mount Holly Springs, PA | $40.19 | $40.19 – $40.19 | 3,962 | 1 |
| Corinth, TX | $27.57 | $9.07 – $28.55 | 3,963 | 3 |
| Reedsville, WI | $29.42 | $29.42 – $29.42 | 3,964 | 1 |
| Kermit, WV | $23.48 | $12.85 – $40.17 | 3,964 | 2 |
| Lamesa, TX | $118.05 | $18.33 – $215.02 | 3,965 | 5 |
| Fort Lee, VA | $57.62 | $20.20 – $67.48 | 3,968 | 5 |
| Albany, MN | $77.98 | $56.61 – $136.30 | 3,968 | 9 |
| Wittmann, AZ | $69.50 | $2.51 – $195.28 | 3,971 | 3 |
| Elmira, MI | $14.69 | $14.69 – $14.69 | 3,972 | 1 |
| Letcher, KY | $38.12 | $38.12 – $38.12 | 3,972 | 1 |
| Cookson, OK | $34.94 | $20.36 – $50.81 | 3,972 | 3 |
| Weldon, NC | $44.30 | $44.30 – $44.30 | 3,973 | 1 |
| Burlington, WA | $47.00 | $31.06 – $79.09 | 3,976 | 6 |
| Henderson, LA | $22.08 | $22.08 – $22.08 | 3,981 | 1 |
| Taylor, TX | $26.40 | $8.30 – $117.39 | 3,984 | 10 |
| Lake City, MI | $40.20 | $37.52 – $59.74 | 3,987 | 2 |
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.