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 |
|---|---|---|---|---|
| Avalon, CA | $12.80 | $2.51 – $34.70 | 4,852 | 3 |
| Carlisle, OH | $48.10 | $38.95 – $63.58 | 4,855 | 4 |
| East Palatka, FL | $36.23 | $15.43 – $68.49 | 4,863 | 6 |
| East Granby, CT | $27.43 | $0.10 – $73.18 | 4,864 | 9 |
| Vineyard Haven, MA | $31.44 | $0.00 – $56.20 | 4,867 | 6 |
| Atkins, IA | $0.03 | $0.03 – $0.03 | 4,869 | 1 |
| Wisc Rapids, WI | $31.22 | $15.46 – $31.42 | 4,871 | 3 |
| Clarkville, TN | $36.11 | $28.61 – $37.39 | 4,875 | 3 |
| Waban, MA | $42.65 | $34.48 – $42.80 | 4,885 | 2 |
| Pageland, SC | $55.35 | $45.83 – $68.06 | 4,886 | 4 |
| Cherry Valley, IL | $53.34 | $48.87 – $73.03 | 4,888 | 4 |
| Mabank, TX | $27.31 | $4.92 – $34.78 | 4,888 | 6 |
| North Aurora, IL | $44.54 | $0.00 – $55.29 | 4,888 | 7 |
| Clermont, NJ | $66.72 | $66.72 – $66.72 | 4,889 | 1 |
| Center Point, IA | $35.52 | $34.18 – $36.44 | 4,891 | 2 |
| Sullivan, IL | $16.86 | $0.57 – $56.43 | 4,894 | 6 |
| Minneapolis, KS | $29.53 | $17.31 – $37.09 | 4,895 | 7 |
| Rancho Curamonga, CA | $73.66 | $73.66 – $73.66 | 4,896 | 1 |
| Milaca, MN | $75.63 | $51.40 – $93.58 | 4,897 | 7 |
| Oxford, PA | $34.90 | $0.00 – $48.64 | 4,897 | 7 |
| Fredericksburg, IA | $34.44 | $0.00 – $34.78 | 4,898 | 2 |
| South Salem, NY | $135.33 | $135.33 – $135.33 | 4,900 | 1 |
| Laie, HI | $131.00 | $29.20 – $181.97 | 4,900 | 3 |
| Oskaloosa, KS | $26.99 | $26.77 – $28.25 | 4,906 | 3 |
| Tilton, IL | $40.38 | $40.38 – $40.38 | 4,906 | 1 |
| Nolensville, TN | $30.66 | $7.04 – $70.57 | 4,907 | 7 |
| Oakmont, PA | $46.79 | $37.22 – $54.87 | 4,909 | 10 |
| Old Fort, NC | $55.88 | $53.86 – $67.52 | 4,913 | 5 |
| Pacolet, SC | $64.01 | $56.38 – $73.35 | 4,913 | 2 |
| Edgewater, FL | $51.51 | $15.47 – $79.91 | 4,915 | 8 |
| Blasdell, NY | $23.96 | $12.51 – $30.05 | 4,918 | 3 |
| Belmont, NY | $58.77 | $51.32 – $70.76 | 4,921 | 3 |
| Belvidere, NJ | $28.82 | $2.49 – $46.23 | 4,927 | 5 |
| Bayfield, CO | $85.54 | $73.32 – $159.07 | 4,928 | 3 |
| Versailles, IN | $59.29 | $47.94 – $69.31 | 4,929 | 3 |
| South Boardman, MI | $3.88 | $3.88 – $3.88 | 4,931 | 1 |
| South Setauket, NY | $60.84 | $37.10 – $125.91 | 4,934 | 7 |
| Minster, OH | $32.72 | $25.52 – $46.28 | 4,938 | 7 |
| Sibley, IA | $34.61 | $13.92 – $58.60 | 4,938 | 8 |
| Minier, IL | $45.84 | $45.84 – $45.84 | 4,938 | 1 |
| Pleasant Ridge, MI | $60.28 | $49.44 – $60.45 | 4,940 | 3 |
| Utica, MI | $79.13 | $53.69 – $79.58 | 4,942 | 2 |
| Mc Grath, AK | $20.70 | $0.40 – $500.13 | 4,948 | 3 |
| Harlan, IN | $49.72 | $49.72 – $49.72 | 4,949 | 1 |
| Bernardsville, NJ | $59.06 | $10.48 – $288.35 | 4,952 | 8 |
| Hoosick Falls, NY | $65.68 | $29.95 – $80.35 | 4,954 | 4 |
| Mahwah, NJ | $55.51 | $1.37 – $131.16 | 4,955 | 9 |
| Le Roy, IL | $55.06 | $55.06 – $55.06 | 4,956 | 1 |
| Oaklyn, NJ | $15.81 | $15.81 – $15.81 | 4,956 | 1 |
| New Middletown, OH | $39.60 | $34.06 – $47.61 | 4,963 | 3 |
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.