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 |
|---|---|---|---|---|
| Cuba, MO | $68.99 | $19.58 – $78.86 | 4,433 | 5 |
| Horton, KS | $275.67 | $140.99 – $504.63 | 4,433 | 4 |
| Baldwin Harbour, NY | $123.31 | $123.31 – $123.31 | 4,435 | 1 |
| Bainbridge, GA | $51.96 | $0.00 – $59.04 | 4,435 | 5 |
| Karnack, TX | $56.14 | $56.14 – $56.14 | 4,440 | 1 |
| W Lafayette, IN | $108.74 | $108.74 – $108.74 | 4,442 | 1 |
| Markle, IN | $64.74 | $44.28 – $68.29 | 4,442 | 2 |
| Dewitt, AR | $33.77 | $33.77 – $33.77 | 4,448 | 1 |
| Solvang, CA | $50.10 | $0.00 – $152.12 | 4,449 | 16 |
| Enterprise, MS | $150.21 | $64.53 – $175.71 | 4,451 | 2 |
| Penacook, NH | $36.06 | $15.06 – $63.75 | 4,452 | 10 |
| Midland, NC | $53.67 | $36.87 – $61.32 | 4,453 | 5 |
| Burlington, IN | $52.59 | $52.59 – $52.59 | 4,455 | 1 |
| Kilmichael, MS | $49.39 | $26.25 – $117.57 | 4,458 | 4 |
| Refugio, TX | $43.09 | $36.50 – $44.04 | 4,459 | 2 |
| N Kingsville, OH | $25.81 | $25.81 – $25.81 | 4,462 | 1 |
| Newbury, MA | $28.69 | $27.53 – $43.89 | 4,466 | 2 |
| Canby, MN | $156.09 | $13.57 – $190.91 | 4,467 | 8 |
| Indian Island, ME | $4.10 | $4.10 – $4.10 | 4,468 | 1 |
| Colton, OR | $73.39 | $73.39 – $73.39 | 4,472 | 1 |
| South Attleboro, MA | $38.98 | $8.96 – $64.05 | 4,475 | 7 |
| Leipsic, OH | $39.62 | $39.58 – $57.76 | 4,478 | 2 |
| Lovelock, NV | $78.01 | $0.00 – $80.10 | 4,478 | 2 |
| Moweaqua, IL | $22.82 | $0.00 – $40.14 | 4,479 | 4 |
| Wymore, NE | $177.38 | $100.19 – $185.85 | 4,482 | 5 |
| College Park, GA | $75.37 | $3.78 – $95.86 | 4,485 | 4 |
| Eastover, NC | $44.45 | $8.17 – $66.27 | 4,485 | 6 |
| Lafayette, CA | $37.42 | $0.00 – $103.95 | 4,486 | 9 |
| Mt Airy, NC | $47.92 | $45.87 – $57.17 | 4,487 | 2 |
| Roseville, IL | $30.97 | $0.00 – $51.98 | 4,487 | 2 |
| Cimarron, NM | $42.15 | $39.33 – $52.59 | 4,493 | 3 |
| Livonia, LA | $8.89 | $0.00 – $13.73 | 4,494 | 4 |
| Depere, WI | $36.22 | $30.97 – $44.65 | 4,496 | 5 |
| Endlewood, NJ | $16.64 | $16.64 – $16.64 | 4,496 | 1 |
| Georgia, VT | $79.74 | $25.56 – $89.84 | 4,502 | 3 |
| Blades, DE | $41.96 | $24.21 – $48.26 | 4,503 | 2 |
| Greenfield, NH | $38.94 | $38.94 – $38.94 | 4,504 | 1 |
| Eddystone, PA | $48.40 | $10.40 – $57.53 | 4,505 | 4 |
| Round Lake, IL | $0.23 | $0.17 – $15.34 | 4,507 | 2 |
| Oriskany Falls, NY | $52.82 | $49.87 – $67.12 | 4,509 | 2 |
| Dexter, MI | $126.44 | $44.25 – $209.61 | 4,509 | 5 |
| Ellicottville, NY | $103.74 | $72.07 – $112.85 | 4,510 | 3 |
| Newberry, IN | $48.59 | $47.64 – $52.39 | 4,515 | 2 |
| Willow Park, TX | $46.09 | $2.07 – $71.53 | 4,525 | 13 |
| Marble Hill, MO | $43.25 | $14.12 – $58.42 | 4,525 | 3 |
| Cloverdale, CA | $11.51 | $2.21 – $43.73 | 4,528 | 5 |
| Hardeeville, SC | $88.23 | $61.75 – $197.69 | 4,534 | 4 |
| Antrim, NH | $86.04 | $83.59 – $142.91 | 4,538 | 3 |
| Warm Springs, GA | $74.51 | $70.79 – $112.36 | 4,541 | 3 |
| Council, ID | $32.23 | $0.00 – $58.26 | 4,543 | 6 |
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.