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 |
|---|---|---|---|---|
| Stinson Beach, CA | $3.03 | $3.03 – $3.03 | 4,968 | 1 |
| North Mankato, MN | $69.55 | $48.39 – $100.87 | 4,975 | 14 |
| Bridgewater, VA | $49.16 | $29.48 – $63.23 | 4,975 | 5 |
| E Setauket, NY | $73.63 | $38.10 – $76.13 | 4,978 | 4 |
| Tipton, OK | $71.08 | $71.08 – $71.08 | 4,978 | 1 |
| Medicine Lodge, KS | $111.34 | $24.64 – $130.20 | 4,980 | 2 |
| Hildale, UT | $62.85 | $0.00 – $66.51 | 4,983 | 3 |
| Loving, NM | $118.35 | $118.35 – $118.35 | 4,984 | 1 |
| Oakboro, NC | $48.87 | $43.44 – $53.29 | 4,989 | 3 |
| Elgin, TN | $33.75 | $33.75 – $33.75 | 4,990 | 1 |
| Bracey, VA | $52.50 | $32.33 – $58.51 | 4,991 | 4 |
| North Branch, MI | $64.57 | $57.60 – $65.26 | 4,995 | 2 |
| Goochland, VA | $54.75 | $12.41 – $63.15 | 4,999 | 3 |
| Oakley, KS | $134.59 | $27.28 – $153.92 | 5,001 | 6 |
| Harrington, DE | $15.11 | $0.00 – $34.05 | 5,007 | 7 |
| Mountain House, CA | $177.47 | $0.00 – $179.66 | 5,012 | 2 |
| Nebo, NC | $40.39 | $30.40 – $52.65 | 5,022 | 6 |
| Fort Jones, CA | $0.75 | $0.00 – $12.26 | 5,022 | 3 |
| Tipton, MO | $105.60 | $44.99 – $106.96 | 5,022 | 4 |
| Mechanicville, NY | $55.62 | $40.67 – $78.69 | 5,028 | 8 |
| Boydton, VA | $47.85 | $17.09 – $78.64 | 5,028 | 4 |
| Mc Coll, SC | $222.42 | $201.96 – $334.63 | 5,030 | 4 |
| Mooresburg, TN | $37.82 | $31.00 – $42.99 | 5,033 | 2 |
| Vanceboro, NC | $39.83 | $0.00 – $45.11 | 5,035 | 4 |
| Medaryville, IN | $38.10 | $38.10 – $38.10 | 5,035 | 1 |
| College Corner, OH | $83.59 | $83.59 – $83.59 | 5,040 | 1 |
| Mount Olive, IL | $1.10 | $0.00 – $76.13 | 5,042 | 2 |
| Wickliffe, OH | $35.65 | $21.14 – $60.60 | 5,046 | 6 |
| Fairfield, ID | $15.13 | $1.57 – $55.53 | 5,046 | 3 |
| Mosheim, TN | $57.38 | $14.88 – $67.77 | 5,049 | 2 |
| Star City, AR | $17.96 | $0.00 – $29.56 | 5,051 | 7 |
| Mcclellanville, SC | $61.45 | $21.23 – $117.51 | 5,053 | 2 |
| Kirkwood, MO | $51.66 | $38.50 – $87.24 | 5,056 | 9 |
| Hopewell Jct, NY | $7.63 | $4.66 – $124.10 | 5,059 | 2 |
| Luke Afb, AZ | $76.57 | $6.28 – $100.83 | 5,059 | 6 |
| Lansford, PA | $28.14 | $28.14 – $28.14 | 5,060 | 1 |
| Big Lake, MN | $74.94 | $61.36 – $90.14 | 5,062 | 4 |
| Wellesley Hills, MA | $45.11 | $4.87 – $121.08 | 5,065 | 10 |
| Naturita, CO | $104.62 | $66.71 – $251.79 | 5,067 | 7 |
| Iiwaco, WA | $10.89 | $10.89 – $10.89 | 5,072 | 1 |
| Harrison Twp, MI | $56.61 | $56.61 – $56.61 | 5,073 | 1 |
| Leon Valley, TX | $61.95 | $61.95 – $61.95 | 5,080 | 1 |
| Heath, TX | $0.01 | $0.01 – $0.01 | 5,083 | 1 |
| Eglin, FL | $54.58 | $54.58 – $54.58 | 5,083 | 1 |
| Royersford, PA | $48.29 | $0.00 – $69.33 | 5,085 | 11 |
| Caquas, PR | $28.42 | $0.00 – $47.51 | 5,087 | 3 |
| Mt Vernon, WA | $24.58 | $24.45 – $40.23 | 5,091 | 2 |
| St Clairsvillle, OH | $28.75 | $28.75 – $28.75 | 5,095 | 1 |
| Greensboro, MD | $169.56 | $166.42 – $170.87 | 5,098 | 3 |
| Canutillo, TX | $73.23 | $39.16 – $100.25 | 5,100 | 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.