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 |
|---|---|---|---|---|
| Fairfield, TX | $18.49 | $15.66 – $70.72 | 6,302 | 5 |
| Phillipsburg, KS | $133.49 | $29.30 – $152.76 | 6,315 | 3 |
| Glen Rose, TX | $43.52 | $34.57 – $54.89 | 6,326 | 8 |
| Richburg, SC | $58.74 | $39.35 – $74.79 | 6,329 | 6 |
| Kingsland, GA | $51.71 | $1.04 – $118.46 | 6,332 | 12 |
| Winnsboro, TX | $31.33 | $23.24 – $45.33 | 6,332 | 6 |
| West Saint Paul, MN | $71.54 | $41.68 – $214.90 | 6,333 | 15 |
| Usaf Academy, CO | $39.20 | $0.12 – $129.15 | 6,340 | 12 |
| Ozark, AR | $26.54 | $22.92 – $27.87 | 6,343 | 4 |
| St. Henry, OH | $43.25 | $43.25 – $43.25 | 6,347 | 1 |
| Sauk City, WI | $27.50 | $0.00 – $42.64 | 6,348 | 21 |
| Marlinton, WV | $9.95 | $0.01 – $15.97 | 6,350 | 3 |
| Waukon, IA | $36.01 | $0.00 – $46.43 | 6,352 | 12 |
| Berwick, ME | $46.23 | $42.63 – $50.72 | 6,354 | 3 |
| Lusby, MD | $99.93 | $99.26 – $101.98 | 6,358 | 2 |
| Brimingham, AL | $184.56 | $184.56 – $184.56 | 6,359 | 1 |
| Deforest, WI | $27.13 | $11.08 – $149.41 | 6,361 | 10 |
| Brownsboro, AL | $42.18 | $42.12 – $70.93 | 6,371 | 2 |
| Delafield, WI | $35.77 | $22.77 – $109.39 | 6,371 | 13 |
| Berlin, OH | $47.67 | $29.56 – $307.02 | 6,373 | 9 |
| Warren, RI | $63.13 | $12.25 – $81.32 | 6,373 | 6 |
| Stanley, NC | $50.80 | $10.33 – $67.82 | 6,373 | 9 |
| Woodland, AL | $4.65 | $0.00 – $4.76 | 6,374 | 3 |
| Boyton Beach, FL | $109.99 | $109.99 – $109.99 | 6,379 | 1 |
| Yellville, AR | $36.22 | $3.03 – $49.85 | 6,380 | 6 |
| Bristol, NH | $19.53 | $0.00 – $296.12 | 6,383 | 8 |
| Walker, MN | $91.54 | $47.41 – $210.17 | 6,383 | 5 |
| Holly, CO | $193.28 | $193.28 – $193.28 | 6,393 | 1 |
| Williamsport, MD | $88.58 | $31.72 – $110.04 | 6,394 | 6 |
| Quaker City, OH | $19.87 | $0.67 – $20.77 | 6,397 | 2 |
| Ira, MI | $76.42 | $76.42 – $76.42 | 6,402 | 1 |
| Clifton, IL | $42.17 | $38.45 – $44.06 | 6,403 | 3 |
| Marietta, PA | $48.41 | $46.42 – $50.20 | 6,409 | 4 |
| Rolla, ND | $144.07 | $104.29 – $179.06 | 6,410 | 4 |
| Andrews, SC | $65.45 | $39.71 – $130.55 | 6,411 | 6 |
| Hi Hat, KY | $32.21 | $32.21 – $32.21 | 6,414 | 1 |
| Summerdale, AL | $49.35 | $47.24 – $109.33 | 6,415 | 4 |
| New Havend, CT | $13.03 | $13.03 – $13.03 | 6,416 | 1 |
| Logandale, NV | $42.40 | $42.40 – $42.40 | 6,419 | 1 |
| Saranac, MI | $10.79 | $10.79 – $10.79 | 6,426 | 1 |
| Ocean Shores, WA | $25.89 | $17.27 – $63.35 | 6,426 | 5 |
| Castle Dale, UT | $73.68 | $73.68 – $73.68 | 6,428 | 1 |
| Millville, DE | $69.20 | $1.96 – $148.37 | 6,432 | 6 |
| Fort Huachuca, AZ | $127.14 | $49.44 – $161.68 | 6,433 | 3 |
| Merrimac, MA | $50.29 | $50.29 – $50.29 | 6,434 | 1 |
| Sussex, NJ | $12.37 | $12.37 – $12.37 | 6,444 | 1 |
| Latta, SC | $218.47 | $205.43 – $336.01 | 6,447 | 3 |
| Mathews, VA | $62.53 | $41.89 – $74.74 | 6,452 | 8 |
| Red Lion, PA | $54.90 | $42.46 – $62.02 | 6,454 | 12 |
| Umatilla, FL | $27.02 | $0.00 – $86.09 | 6,457 | 7 |
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.