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 |
|---|---|---|---|---|
| Cannon Beach, OR | $70.79 | $70.79 – $70.79 | 4,250 | 1 |
| Edina, MO | $73.42 | $16.78 – $86.46 | 4,252 | 4 |
| Shellman, GA | $54.10 | $49.01 – $57.43 | 4,252 | 2 |
| Pointblank, TX | $56.54 | $14.13 – $56.82 | 4,252 | 2 |
| Swansboro, NC | $47.03 | $36.89 – $51.20 | 4,253 | 3 |
| Rices Landing, PA | $49.72 | $49.72 – $49.72 | 4,255 | 1 |
| Moselle, MS | $46.46 | $12.95 – $63.87 | 4,260 | 4 |
| Middleport, NY | $46.27 | $42.30 – $53.93 | 4,262 | 4 |
| Ione, WA | $43.13 | $22.87 – $62.22 | 4,264 | 4 |
| Pearl Harbor, HI | $25.30 | $2.45 – $53.68 | 4,265 | 7 |
| Mackinaw City, MI | $28.07 | $28.07 – $28.07 | 4,266 | 1 |
| Dawson, MN | $171.90 | $123.21 – $184.80 | 4,267 | 7 |
| Unionville, MO | $59.25 | $16.31 – $131.89 | 4,267 | 7 |
| Wayne City, IL | $9.62 | $0.00 – $36.05 | 4,267 | 3 |
| N Manchester, IN | $61.39 | $57.99 – $64.90 | 4,268 | 2 |
| Cerro Gordo, IL | $0.82 | $0.02 – $96.58 | 4,273 | 3 |
| Oak Park Heights, MN | $75.98 | $21.45 – $87.34 | 4,276 | 15 |
| Faison, NC | $10.49 | $0.00 – $74.58 | 4,279 | 8 |
| Shirley, AR | $27.01 | $27.01 – $27.01 | 4,292 | 1 |
| Converse, IN | $55.19 | $55.19 – $55.19 | 4,292 | 1 |
| Creve Coeur, IL | $66.57 | $66.57 – $66.57 | 4,293 | 1 |
| Clinton, CT | $69.04 | $0.00 – $96.09 | 4,296 | 9 |
| Monroe Township, PA | $0.12 | $0.00 – $0.15 | 4,300 | 2 |
| Calhan, CO | $199.60 | $199.60 – $199.60 | 4,305 | 1 |
| Gideon, MO | $44.79 | $44.79 – $44.79 | 4,308 | 1 |
| Mountain Lake, MN | $82.98 | $25.70 – $96.70 | 4,309 | 5 |
| Clayton, OH | $49.39 | $36.82 – $49.83 | 4,309 | 2 |
| Boswell, OK | $18.93 | $4.34 – $26.57 | 4,311 | 2 |
| Tishomingo, MS | $73.78 | $20.64 – $137.67 | 4,315 | 4 |
| Great Mills, MD | $32.65 | $8.40 – $45.00 | 4,316 | 3 |
| Crane, MO | $86.96 | $86.42 – $87.74 | 4,317 | 2 |
| Ft. Belvoir, VA | $51.96 | $36.01 – $115.12 | 4,319 | 4 |
| North Royalton, OH | $46.98 | $26.52 – $61.01 | 4,319 | 11 |
| Lumberton, TX | $64.74 | $0.00 – $74.02 | 4,321 | 6 |
| Dundee, NY | $67.72 | $32.46 – $69.65 | 4,322 | 4 |
| Mound City, KS | $150.67 | $16.78 – $162.83 | 4,322 | 6 |
| Mogadore, OH | $47.75 | $29.39 – $50.55 | 4,328 | 4 |
| Pendleton, SC | $63.99 | $35.65 – $281.73 | 4,331 | 6 |
| Bethlehem, CT | $47.55 | $38.05 – $57.71 | 4,331 | 4 |
| Mt Pleasant Mills, PA | $38.25 | $37.65 – $40.03 | 4,332 | 2 |
| Waymart, PA | $2.72 | $2.19 – $27.22 | 4,334 | 2 |
| Delmont, PA | $49.66 | $33.37 – $55.71 | 4,335 | 9 |
| Heathsville, VA | $47.52 | $33.18 – $59.66 | 4,336 | 6 |
| Woodlands, TX | $58.05 | $51.98 – $77.03 | 4,336 | 2 |
| Sun Valley, NV | $50.95 | $0.00 – $55.29 | 4,337 | 4 |
| Longville, MN | $160.01 | $160.01 – $160.01 | 4,338 | 1 |
| Absarokee, MT | $73.95 | $73.95 – $73.95 | 4,340 | 1 |
| Saint Johnsbury, VT | $11.31 | $0.59 – $93.31 | 4,341 | 5 |
| Topmost, KY | $39.37 | $39.37 – $39.37 | 4,343 | 1 |
| Monmouth Junction, NJ | $45.60 | $8.66 – $66.65 | 4,347 | 5 |
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.