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 |
|---|---|---|---|---|
| Sipsey, AL | $63.96 | $45.72 – $97.36 | 7,344 | 2 |
| Mc Gregor, TX | $37.55 | $37.55 – $37.55 | 7,349 | 1 |
| Springerville, AZ | $15.73 | $0.10 – $111.62 | 7,351 | 6 |
| Sterling, KS | $186.30 | $163.92 – $186.34 | 7,355 | 2 |
| Kewaskum, WI | $33.86 | $21.41 – $48.28 | 7,356 | 8 |
| Goreville, IL | $0.00 | $0.00 – $0.00 | 7,359 | 1 |
| Bude, MS | $63.00 | $24.16 – $99.68 | 7,360 | 3 |
| S Richmond Hills, NY | $72.65 | $72.65 – $72.65 | 7,363 | 1 |
| Potlatch, ID | $66.68 | $0.66 – $70.47 | 7,370 | 4 |
| Hobe Sound, FL | $19.93 | $6.94 – $39.95 | 7,371 | 3 |
| Grand Marais, MN | $185.20 | $36.98 – $311.34 | 7,377 | 9 |
| Warroad, MN | $43.25 | $40.63 – $65.06 | 7,378 | 4 |
| Lytle, TX | $51.71 | $26.30 – $74.97 | 7,378 | 5 |
| Emporium, PA | $8.73 | $0.12 – $41.20 | 7,378 | 3 |
| Dysart, IA | $38.14 | $38.14 – $38.14 | 7,380 | 1 |
| Shawneetown, IL | $0.00 | $0.00 – $0.00 | 7,382 | 1 |
| Park Hills, MO | $18.01 | $17.84 – $19.62 | 7,383 | 3 |
| Richwood, WV | $33.74 | $0.39 – $37.47 | 7,385 | 3 |
| Altamont, NY | $94.95 | $0.00 – $101.37 | 7,386 | 9 |
| Rutherford, TN | $32.04 | $23.05 – $32.65 | 7,406 | 3 |
| Willow Street, PA | $59.71 | $24.39 – $91.86 | 7,416 | 15 |
| Plattsburg, MO | $49.64 | $16.97 – $57.06 | 7,416 | 4 |
| Ramsey, MN | $73.00 | $59.57 – $228.52 | 7,419 | 14 |
| Isle Of Palms, SC | $70.89 | $39.37 – $74.72 | 7,424 | 2 |
| Sandersville, MS | $69.30 | $27.51 – $70.32 | 7,426 | 3 |
| Tavernier, FL | $71.63 | $10.46 – $107.53 | 7,428 | 9 |
| Neah Bay, WA | $44.33 | $26.29 – $55.84 | 7,429 | 9 |
| Mt Shasta, CA | $8.55 | $3.03 – $41.32 | 7,432 | 2 |
| Napavine, WA | $52.97 | $44.45 – $73.79 | 7,441 | 3 |
| Smithers, WV | $25.26 | $0.00 – $63.87 | 7,442 | 4 |
| Slaton, TX | $28.45 | $0.12 – $42.72 | 7,446 | 3 |
| Stansbury Park, UT | $53.58 | $37.01 – $417.49 | 7,454 | 10 |
| Scuddy, KY | $9.10 | $9.10 – $9.10 | 7,454 | 1 |
| Woodville, AL | $0.00 | $0.00 – $0.00 | 7,456 | 2 |
| Carnegie, PA | $44.96 | $16.01 – $67.00 | 7,457 | 11 |
| Merriam, KS | $45.47 | $17.13 – $207.79 | 7,457 | 40 |
| Johnson Creek, WI | $17.16 | $4.84 – $31.14 | 7,460 | 6 |
| Tecumseh, OK | $143.37 | $92.84 – $174.36 | 7,460 | 2 |
| Stockton Springs, ME | $16.59 | $16.59 – $16.59 | 7,463 | 1 |
| Millis, MA | $97.92 | $2.84 – $122.28 | 7,469 | 9 |
| Gosport, IN | $57.81 | $49.72 – $105.40 | 7,481 | 5 |
| Kenly, NC | $43.55 | $0.00 – $51.36 | 7,484 | 7 |
| Atascocita, TX | $52.40 | $36.55 – $66.48 | 7,487 | 4 |
| Washburn, TN | $39.29 | $29.18 – $45.16 | 7,487 | 3 |
| Wilson, MI | $0.73 | $0.73 – $0.73 | 7,489 | 1 |
| Ensenada, PR | $0.82 | $0.82 – $0.82 | 7,490 | 1 |
| Trent Woods, NC | $49.34 | $19.22 – $85.44 | 7,492 | 5 |
| Jbsa Randolph, TX | $43.55 | $31.51 – $92.30 | 7,497 | 5 |
| Tustin, MI | $22.83 | $1.83 – $59.43 | 7,503 | 4 |
| Robstown, TX | $34.61 | $13.75 – $59.41 | 7,512 | 6 |
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.