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 |
|---|---|---|---|---|
| Laurens, IA | $0.33 | $0.33 – $0.33 | 5,896 | 1 |
| Flanagan, IL | $38.37 | $0.00 – $54.21 | 5,896 | 3 |
| Hurt, VA | $46.81 | $39.14 – $57.21 | 5,897 | 4 |
| Gardnerville, NV | $26.80 | $0.00 – $78.44 | 5,901 | 15 |
| Robins Air Force Base, GA | $22.84 | $22.84 – $22.84 | 5,902 | 1 |
| Mccleary, WA | $57.25 | $13.47 – $69.90 | 5,902 | 4 |
| Maxton, NC | $63.31 | $63.11 – $67.33 | 5,904 | 2 |
| Papaikou, HI | $67.21 | $67.21 – $67.21 | 5,906 | 1 |
| Cedartown, GA | $61.19 | $23.66 – $67.27 | 5,908 | 8 |
| Big Sur, CA | $27.28 | $0.44 – $45.19 | 5,908 | 3 |
| Garrison, KY | $42.65 | $42.65 – $42.65 | 5,913 | 1 |
| Gordon, NE | $85.19 | $0.00 – $109.85 | 5,924 | 8 |
| Shaw Afb, SC | $88.92 | $38.96 – $580.40 | 5,924 | 6 |
| Newcastle, WY | $153.95 | $0.00 – $224.35 | 5,928 | 8 |
| Baltimore, OH | $34.34 | $8.47 – $51.41 | 5,930 | 3 |
| Douglaston, NY | $88.69 | $0.00 – $124.37 | 5,931 | 5 |
| Bentonia, MS | $47.49 | $47.49 – $47.49 | 5,934 | 1 |
| Fairfield, AL | $21.50 | $0.00 – $47.98 | 5,935 | 4 |
| Columbia Heights, MN | $71.32 | $4.13 – $86.74 | 5,935 | 8 |
| Orleans, VT | $8.69 | $8.69 – $8.69 | 5,936 | 1 |
| Olmsted Twp, OH | $36.21 | $17.00 – $50.89 | 5,954 | 9 |
| Toledo, IA | $5.51 | $0.17 – $40.42 | 5,956 | 4 |
| Winfield, IN | $45.55 | $45.46 – $83.83 | 5,956 | 2 |
| Palmyra, IL | $54.73 | $54.73 – $54.73 | 5,957 | 1 |
| Fleetwood, PA | $30.38 | $1.02 – $74.86 | 5,959 | 8 |
| Brinkley, AR | $29.87 | $0.00 – $38.88 | 5,959 | 6 |
| Yale, MI | $56.09 | $56.09 – $56.09 | 5,960 | 1 |
| Clinton, MI | $53.89 | $0.00 – $59.80 | 5,960 | 2 |
| Hanover, NH | $72.64 | $0.00 – $140.75 | 5,962 | 7 |
| Baldwin, GA | $151.40 | $67.03 – $282.63 | 5,965 | 3 |
| Suttons Bay, MI | $56.69 | $0.31 – $74.85 | 5,970 | 4 |
| St Ignatius, MT | $87.85 | $45.96 – $93.65 | 5,971 | 3 |
| Brooks, ME | $14.43 | $14.43 – $14.43 | 5,974 | 1 |
| Postville, IA | $2.69 | $0.01 – $29.22 | 5,976 | 4 |
| California, PA | $65.65 | $0.00 – $74.74 | 5,979 | 3 |
| Palos Park, IL | $45.90 | $21.94 – $64.78 | 5,979 | 17 |
| Ashland, MO | $116.72 | $27.48 – $556.12 | 5,979 | 10 |
| Trujillo Alro, PR | $59.33 | $59.33 – $59.33 | 5,981 | 1 |
| Seekonk, MA | $52.86 | $13.19 – $94.78 | 5,982 | 7 |
| Rio Ranch, NM | $90.83 | $90.83 – $90.83 | 5,985 | 1 |
| Falls Of Rough, KY | $32.28 | $32.28 – $32.28 | 5,986 | 1 |
| Lyons, IL | $62.62 | $37.57 – $64.33 | 5,987 | 3 |
| Milton, KY | $32.55 | $32.32 – $32.64 | 5,997 | 2 |
| Fair Bluff, NC | $35.80 | $32.18 – $36.11 | 5,998 | 2 |
| Mount Arlington, NJ | $72.36 | $36.08 – $102.24 | 5,999 | 7 |
| Vinton, TX | $62.67 | $57.21 – $64.13 | 5,999 | 2 |
| Wayland, MI | $5.08 | $3.23 – $63.50 | 6,008 | 2 |
| Bantam, CT | $76.91 | $8.65 – $89.48 | 6,009 | 2 |
| Mountainair, NM | $146.58 | $146.58 – $146.58 | 6,009 | 1 |
| Laureldale, PA | $22.81 | $8.91 – $55.06 | 6,010 | 4 |
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.