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 |
|---|---|---|---|---|
| Hillsdale, NJ | $27.73 | $27.73 – $27.73 | 5,538 | 1 |
| Ribera, NM | $149.34 | $149.34 – $149.34 | 5,540 | 1 |
| Hillside, IL | $12.22 | $0.00 – $54.06 | 5,541 | 3 |
| Nauvoo, AL | $24.97 | $8.84 – $25.87 | 5,541 | 2 |
| Lake Como, PA | $0.55 | $0.00 – $0.57 | 5,547 | 2 |
| Woodway, TX | $46.35 | $24.55 – $70.50 | 5,553 | 3 |
| New Madison, OH | $24.93 | $1.73 – $38.61 | 5,554 | 4 |
| E Brunswick, NJ | $35.10 | $35.10 – $35.10 | 5,555 | 1 |
| Chadds Ford, PA | $49.27 | $8.14 – $127.77 | 5,555 | 13 |
| Worthington, MA | $22.73 | $6.63 – $49.77 | 5,555 | 3 |
| Sardinia, OH | $43.21 | $35.04 – $50.38 | 5,557 | 6 |
| De Kalb, MS | $44.89 | $0.00 – $155.15 | 5,558 | 7 |
| Valliant, OK | $136.86 | $83.43 – $614.51 | 5,562 | 3 |
| Belleville, PA | $40.16 | $39.75 – $40.48 | 5,563 | 2 |
| Dolton, IL | $0.28 | $0.08 – $25.94 | 5,565 | 2 |
| Belvidere, TN | $51.23 | $51.23 – $51.23 | 5,565 | 1 |
| Otwell, IN | $81.66 | $81.66 – $81.66 | 5,566 | 1 |
| Linwood, PA | $30.77 | $22.10 – $31.03 | 5,569 | 2 |
| Cripple Creek, CO | $43.96 | $16.69 – $423.31 | 5,570 | 6 |
| Pemberville, OH | $119.68 | $119.68 – $119.68 | 5,571 | 1 |
| Big Pine Key, FL | $53.29 | $20.85 – $120.77 | 5,571 | 4 |
| Ezel, KY | $37.71 | $37.71 – $37.71 | 5,572 | 1 |
| Phoenox, AZ | $58.46 | $58.46 – $58.46 | 5,573 | 1 |
| Webster, SD | $89.08 | $89.08 – $89.08 | 5,574 | 1 |
| Minden, NE | $58.14 | $23.56 – $144.38 | 5,579 | 11 |
| Pinehurst, ID | $58.65 | $58.65 – $58.65 | 5,585 | 1 |
| Arcadia, WI | $89.00 | $24.87 – $268.56 | 5,585 | 7 |
| Grafton, ND | $105.69 | $44.52 – $128.37 | 5,586 | 11 |
| Hardy, VA | $55.83 | $33.22 – $91.90 | 5,588 | 10 |
| Henderonville, NC | $72.59 | $72.59 – $72.59 | 5,590 | 1 |
| Lisbon, CT | $24.45 | $0.00 – $37.50 | 5,593 | 4 |
| Marmaduke, AR | $24.12 | $24.12 – $24.12 | 5,593 | 1 |
| Sunman, IN | $40.93 | $40.93 – $40.93 | 5,598 | 1 |
| Aurora, OH | $62.10 | $1.90 – $101.14 | 5,602 | 9 |
| South Pasadena, FL | $44.74 | $4.51 – $61.26 | 5,604 | 12 |
| Delta, OH | $59.12 | $24.44 – $107.64 | 5,606 | 7 |
| Lincoln, DE | $54.16 | $54.16 – $54.16 | 5,607 | 1 |
| Squaw Valley, CA | $5.55 | $1.66 – $14.68 | 5,611 | 3 |
| Glenarden, MD | $113.99 | $76.00 – $114.76 | 5,611 | 3 |
| Seagoville, TX | $28.80 | $1.47 – $32.60 | 5,611 | 4 |
| Kelseyville, CA | $21.61 | $0.00 – $32.64 | 5,611 | 6 |
| Windsor, NY | $65.13 | $49.46 – $66.74 | 5,613 | 4 |
| Kings Mountain, KY | $30.64 | $30.64 – $30.64 | 5,614 | 1 |
| Selbyville, DE | $88.72 | $2.37 – $122.53 | 5,617 | 7 |
| San Martin, CA | $4.46 | $3.50 – $33.45 | 5,617 | 3 |
| Winnebago, NE | $45.39 | $0.00 – $370.12 | 5,619 | 7 |
| West Henrietta, NY | $95.22 | $72.57 – $105.75 | 5,631 | 3 |
| Glide, OR | $51.95 | $51.36 – $58.17 | 5,638 | 2 |
| Baileyton, AL | $56.74 | $0.00 – $68.86 | 5,638 | 6 |
| Coatsville, PA | $63.31 | $51.96 – $66.06 | 5,640 | 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.