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 |
|---|---|---|---|---|
| Mio, MI | $27.26 | $14.98 – $55.01 | 7,872 | 5 |
| Durand, WI | $25.82 | $8.32 – $57.27 | 7,873 | 10 |
| Holtville, CA | $30.24 | $8.88 – $41.09 | 7,874 | 2 |
| Pinckney, MI | $64.22 | $11.35 – $67.75 | 7,880 | 3 |
| Green River, WY | $27.03 | $1.03 – $54.59 | 7,882 | 7 |
| Sanborn, IA | $2.05 | $0.00 – $32.37 | 7,885 | 3 |
| Huntertown, IN | $47.14 | $43.72 – $105.73 | 7,887 | 3 |
| East Peoria, IL | $43.40 | $12.35 – $318.75 | 7,893 | 16 |
| Stafford Township, NJ | $62.14 | $33.28 – $102.36 | 7,895 | 3 |
| New Riegel, OH | $38.30 | $22.47 – $47.22 | 7,897 | 2 |
| Manson, IA | $8.39 | $0.14 – $14.79 | 7,902 | 2 |
| Lexington, MI | $65.46 | $59.24 – $67.24 | 7,906 | 2 |
| Harbor Beach, MI | $54.47 | $54.47 – $54.47 | 7,906 | 1 |
| Skippack, PA | $46.52 | $46.26 – $70.06 | 7,921 | 3 |
| Fountain Inn, SC | $47.35 | $14.32 – $86.42 | 7,923 | 7 |
| Horseshoe Bend, AR | $27.57 | $0.06 – $33.01 | 7,923 | 7 |
| Plain City, OH | $42.39 | $37.68 – $46.36 | 7,924 | 3 |
| E Providence, RI | $46.82 | $35.56 – $65.91 | 7,929 | 9 |
| Pine Knoll Shores, NC | $93.29 | $93.29 – $93.29 | 7,934 | 1 |
| Washington, VA | $34.68 | $16.70 – $65.03 | 7,939 | 4 |
| Fordland, MO | $82.01 | $73.04 – $101.09 | 7,940 | 5 |
| Swan Lake, NY | $36.77 | $36.77 – $36.77 | 7,940 | 1 |
| Nathalie, VA | $50.94 | $40.67 – $61.29 | 7,945 | 4 |
| Saint Francis, WI | $29.97 | $26.01 – $57.42 | 7,946 | 5 |
| American Canyon, CA | $12.78 | $0.99 – $53.83 | 7,950 | 6 |
| Staffordsville, KY | $21.53 | $21.53 – $21.53 | 7,958 | 1 |
| Nyssa, OR | $28.90 | $9.07 – $66.55 | 7,959 | 5 |
| Menominee, MI | $95.53 | $21.57 – $539.41 | 7,959 | 7 |
| Old Forge, PA | $26.12 | $0.00 – $115.02 | 7,962 | 6 |
| Corinth, ME | $9.98 | $9.98 – $9.98 | 7,966 | 1 |
| Cape Elizabeth, ME | $37.03 | $0.40 – $41.74 | 7,968 | 6 |
| Osceola, MO | $101.75 | $16.58 – $112.53 | 7,972 | 6 |
| Ardmore, PA | $41.71 | $14.06 – $115.21 | 7,982 | 10 |
| Kingman, KS | $143.10 | $18.90 – $186.96 | 7,990 | 7 |
| Woodstock, NY | $83.32 | $39.12 – $132.45 | 7,991 | 9 |
| Buchanan, VA | $56.48 | $55.89 – $67.85 | 7,991 | 2 |
| Lower Brule, SD | $489.99 | $396.80 – $528.35 | 7,996 | 2 |
| Bridgeport, NE | $110.26 | $13.40 – $276.30 | 8,001 | 8 |
| Anderson, MO | $95.99 | $59.17 – $155.77 | 8,001 | 8 |
| Harrington Park, NJ | $39.26 | $3.18 – $57.91 | 8,005 | 12 |
| Clearfield, UT | $63.35 | $30.90 – $63.65 | 8,010 | 2 |
| Lake Zurich, IL | $56.06 | $31.52 – $106.40 | 8,019 | 16 |
| Edwardsburg, MI | $53.43 | $31.76 – $90.20 | 8,019 | 6 |
| Blaine, WA | $66.82 | $2.69 – $328.44 | 8,020 | 9 |
| Lockhart, TX | $64.72 | $13.33 – $204.86 | 8,023 | 9 |
| Seward, NE | $84.75 | $13.96 – $163.18 | 8,024 | 14 |
| Pinecrest, FL | $14.44 | $6.70 – $80.19 | 8,024 | 12 |
| Lake Andes, SD | $96.27 | $41.84 – $96.36 | 8,028 | 2 |
| Mechanicsville, MD | $100.79 | $28.00 – $144.61 | 8,028 | 9 |
| Mouthcard, KY | $35.67 | $35.67 – $35.67 | 8,035 | 1 |
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.