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 |
|---|---|---|---|---|
| Afton, VA | $50.46 | $48.43 – $56.29 | 5,342 | 3 |
| Elizabeth, IL | $0.49 | $0.49 – $0.49 | 5,342 | 1 |
| La Porte City, IA | $29.28 | $24.27 – $33.09 | 5,345 | 3 |
| Burlington, CT | $65.05 | $7.16 – $68.56 | 5,346 | 3 |
| Baltimore City, MD | $112.72 | $62.62 – $112.85 | 5,346 | 2 |
| Marseilles, IL | $38.84 | $0.00 – $57.04 | 5,348 | 5 |
| Lacon, IL | $13.13 | $0.00 – $46.52 | 5,349 | 6 |
| Tannersville, PA | $50.45 | $37.06 – $55.18 | 5,350 | 3 |
| South Houston, TX | $80.15 | $80.15 – $80.15 | 5,353 | 1 |
| Onaga, KS | $128.62 | $21.69 – $131.23 | 5,356 | 3 |
| St. James, MO | $41.93 | $23.97 – $41.98 | 5,357 | 2 |
| Manchester, ME | $33.23 | $19.50 – $35.58 | 5,358 | 4 |
| Glenwood, MD | $141.29 | $109.07 – $143.80 | 5,359 | 3 |
| Ratnham, MA | $42.93 | $42.93 – $42.93 | 5,362 | 1 |
| Morenci, AZ | $38.61 | $2.26 – $61.78 | 5,362 | 6 |
| Spring House, PA | $30.69 | $29.30 – $37.63 | 5,370 | 3 |
| Oakdale, CT | $27.52 | $22.00 – $27.68 | 5,373 | 2 |
| Peckville, PA | $44.85 | $33.02 – $81.99 | 5,375 | 4 |
| Plattsbugh, NY | $81.29 | $81.29 – $81.29 | 5,380 | 1 |
| Iberia, MO | $80.50 | $53.56 – $162.88 | 5,383 | 3 |
| North Fond Du Lac, WI | $29.84 | $21.07 – $46.29 | 5,383 | 10 |
| Kanab, UT | $57.98 | $48.27 – $95.72 | 5,384 | 5 |
| Wynantskill, NY | $65.34 | $29.71 – $91.92 | 5,387 | 5 |
| Griffin, IN | $63.13 | $63.13 – $63.13 | 5,387 | 1 |
| Winfield, WV | $185.90 | $68.04 – $190.99 | 5,388 | 2 |
| Rockland, MA | $20.27 | $4.45 – $29.41 | 5,389 | 5 |
| White River, SD | $168.21 | $168.21 – $168.21 | 5,390 | 1 |
| Marshall, AK | $332.90 | $77.30 – $421.76 | 5,394 | 4 |
| Lynchburg, OH | $26.75 | $0.00 – $47.52 | 5,396 | 3 |
| Collbran, CO | $119.42 | $44.26 – $161.43 | 5,400 | 4 |
| Flat Rock, NC | $38.71 | $0.00 – $87.40 | 5,404 | 11 |
| Bells, TN | $40.23 | $39.96 – $52.19 | 5,404 | 2 |
| Stony Point, NY | $67.95 | $8.28 – $86.57 | 5,405 | 8 |
| Lanett, AL | $45.13 | $45.13 – $45.13 | 5,405 | 1 |
| Axton, VA | $47.20 | $47.13 – $68.83 | 5,415 | 2 |
| North Creek, NY | $64.69 | $32.23 – $79.32 | 5,420 | 4 |
| Benton, PA | $39.17 | $39.17 – $39.17 | 5,420 | 1 |
| Miracle, KY | $33.89 | $33.89 – $33.89 | 5,429 | 1 |
| Kinnelon, NJ | $46.67 | $16.49 – $94.56 | 5,431 | 6 |
| Highlands, NJ | $26.98 | $11.17 – $58.33 | 5,432 | 3 |
| Hollister, MO | $69.61 | $25.38 – $97.37 | 5,433 | 7 |
| Forsyth, MT | $0.56 | $0.00 – $97.91 | 5,439 | 2 |
| Rolling Hills Estates, CA | $6.08 | $0.00 – $46.11 | 5,440 | 3 |
| Newfoundland, NJ | $33.56 | $31.92 – $75.63 | 5,444 | 2 |
| Independence, VA | $38.47 | $15.05 – $57.10 | 5,447 | 4 |
| Hagerstown, IN | $62.32 | $35.16 – $74.72 | 5,449 | 3 |
| Yerington, NV | $90.68 | $0.00 – $159.75 | 5,450 | 7 |
| East Dubuque, IL | $38.02 | $38.02 – $38.02 | 5,451 | 1 |
| Fremont, IN | $49.91 | $31.07 – $62.17 | 5,454 | 3 |
| Roanoke, IL | $48.10 | $0.00 – $69.49 | 5,459 | 13 |
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.