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 |
|---|---|---|---|---|
| Granby, CT | $33.91 | $29.26 – $78.33 | 7,209 | 7 |
| Newton Centre, MA | $16.92 | $7.84 – $44.81 | 7,211 | 4 |
| Keystone, WV | $63.02 | $60.86 – $67.80 | 7,212 | 2 |
| Horizon City, TX | $37.72 | $24.53 – $57.25 | 7,216 | 8 |
| Williamsburg, IA | $3.69 | $0.35 – $43.77 | 7,217 | 6 |
| Jeffersonville, OH | $75.27 | $75.27 – $75.27 | 7,221 | 1 |
| Georgetown, IN | $58.79 | $46.00 – $64.98 | 7,225 | 6 |
| Mount Pleasant, IA | $17.93 | $0.00 – $37.53 | 7,228 | 9 |
| Gordo, AL | $29.15 | $4.38 – $70.54 | 7,229 | 4 |
| Chattaroy, WA | $72.38 | $39.09 – $89.71 | 7,233 | 3 |
| Shepherd, MI | $52.67 | $42.18 – $62.14 | 7,238 | 4 |
| Pine City, MN | $92.95 | $0.00 – $119.56 | 7,239 | 6 |
| Middle Island, NY | $12.25 | $9.21 – $25.70 | 7,241 | 2 |
| Brookfield, OH | $42.78 | $28.79 – $44.84 | 7,245 | 5 |
| Ardmore, TN | $34.87 | $14.94 – $63.59 | 7,248 | 5 |
| Elgin, OR | $26.97 | $10.37 – $63.84 | 7,251 | 4 |
| Kenedy, TX | $42.03 | $0.96 – $91.79 | 7,252 | 8 |
| Clarence, IA | $0.41 | $0.41 – $0.41 | 7,255 | 1 |
| Byron, IL | $53.53 | $11.32 – $67.89 | 7,256 | 6 |
| Manchester, MO | $64.86 | $25.13 – $82.55 | 7,260 | 9 |
| Vulcan, MI | $50.56 | $50.56 – $50.56 | 7,261 | 1 |
| Cadott, WI | $29.92 | $20.03 – $33.40 | 7,261 | 2 |
| Mphs, TN | $13.60 | $13.60 – $13.60 | 7,267 | 1 |
| White Lake, MI | $74.59 | $66.44 – $97.84 | 7,267 | 4 |
| Valley Village, CA | $18.19 | $0.00 – $70.81 | 7,269 | 10 |
| Crestwood, IL | $44.22 | $12.40 – $75.42 | 7,271 | 12 |
| Hillsboro, NH | $40.44 | $36.66 – $51.55 | 7,271 | 4 |
| Alden, NY | $50.67 | $41.77 – $64.66 | 7,272 | 5 |
| Meeker, CO | $78.44 | $73.97 – $114.16 | 7,274 | 5 |
| Clayton, NM | $89.97 | $28.53 – $123.55 | 7,275 | 5 |
| Cambridge, VT | $41.83 | $0.00 – $82.79 | 7,276 | 9 |
| Hodge, LA | $7.01 | $0.10 – $22.17 | 7,276 | 2 |
| New Castle, VA | $40.40 | $3.08 – $54.61 | 7,282 | 4 |
| Crystal Falls, MI | $30.90 | $12.91 – $35.14 | 7,283 | 2 |
| Loudonville, NY | $62.02 | $53.37 – $74.53 | 7,285 | 10 |
| Ketchum, ID | $41.96 | $9.54 – $124.33 | 7,286 | 6 |
| Manheim, PA | $48.43 | $28.37 – $55.21 | 7,291 | 8 |
| Valley, NE | $63.65 | $36.90 – $80.65 | 7,295 | 8 |
| Sheridan, MT | $18.30 | $0.00 – $103.35 | 7,297 | 3 |
| Moss Bluff, LA | $48.77 | $48.22 – $55.70 | 7,298 | 2 |
| Harrah, OK | $56.00 | $18.97 – $99.83 | 7,305 | 8 |
| Flushuing, NY | $60.88 | $60.88 – $60.88 | 7,313 | 1 |
| Geneva, NE | $59.04 | $28.27 – $70.27 | 7,320 | 8 |
| Washington, MI | $53.26 | $41.99 – $80.26 | 7,321 | 3 |
| Montgomery, TX | $99.85 | $36.51 – $275.05 | 7,328 | 8 |
| Oologah, OK | $80.05 | $69.83 – $80.39 | 7,329 | 2 |
| Tenino, WA | $40.94 | $14.22 – $52.28 | 7,330 | 4 |
| Bristol, FL | $29.11 | $16.44 – $35.40 | 7,332 | 6 |
| Jemez Pueblo, NM | $69.06 | $8.61 – $457.50 | 7,337 | 5 |
| Ellerbe, NC | $52.53 | $45.79 – $57.61 | 7,339 | 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.