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 |
|---|---|---|---|---|
| Ely, MN | $147.08 | $74.28 – $180.05 | 8,039 | 8 |
| Terra Bella, CA | $12.82 | $12.82 – $12.82 | 8,044 | 1 |
| Jarvisburg, NC | $41.24 | $41.24 – $41.24 | 8,051 | 1 |
| East Rutherford, NJ | $50.01 | $23.50 – $97.81 | 8,053 | 5 |
| Poultney, VT | $83.63 | $83.63 – $83.63 | 8,058 | 1 |
| Bonsall, CA | $0.39 | $0.38 – $1.59 | 8,059 | 2 |
| Scottdale, PA | $47.61 | $30.62 – $68.82 | 8,065 | 7 |
| Belle Fourche, SD | $84.88 | $9.31 – $95.16 | 8,067 | 5 |
| Leopold, IN | $41.51 | $41.51 – $41.51 | 8,071 | 1 |
| De Kalb, TX | $34.02 | $15.07 – $34.28 | 8,073 | 3 |
| North Grosvenordale, CT | $71.86 | $71.86 – $71.86 | 8,076 | 1 |
| Rush, KY | $28.54 | $23.89 – $29.73 | 8,079 | 3 |
| Wade, NC | $71.92 | $0.00 – $125.28 | 8,084 | 6 |
| Mount Holly, NC | $52.27 | $37.05 – $102.08 | 8,091 | 13 |
| San Germain, PR | $0.97 | $0.97 – $0.97 | 8,092 | 1 |
| Belleville, MI | $56.88 | $18.48 – $97.27 | 8,106 | 5 |
| Hopedale, IL | $42.28 | $8.04 – $52.26 | 8,106 | 6 |
| Sandy Springs, GA | $51.26 | $15.86 – $184.30 | 8,107 | 16 |
| Mckenzie, TN | $40.68 | $40.68 – $40.68 | 8,108 | 1 |
| Rowlett, TX | $27.33 | $0.86 – $93.36 | 8,109 | 20 |
| Robertsdale, AL | $118.01 | $0.00 – $220.79 | 8,111 | 8 |
| Marshall, VA | $85.70 | $29.15 – $85.82 | 8,112 | 2 |
| Holly Hill, SC | $177.33 | $38.53 – $188.28 | 8,113 | 4 |
| Douglassville, PA | $51.68 | $17.59 – $88.20 | 8,113 | 14 |
| Jonesboro, GA | $64.00 | $0.00 – $227.08 | 8,115 | 20 |
| Healdton, OK | $73.75 | $30.88 – $74.28 | 8,115 | 2 |
| Levittown, PR | $1.94 | $0.50 – $68.07 | 8,115 | 5 |
| Rock Rapids, IA | $73.22 | $1.66 – $577.25 | 8,118 | 10 |
| Middleburg Hts, OH | $40.79 | $27.60 – $55.32 | 8,120 | 6 |
| South Berwick, ME | $39.32 | $20.76 – $61.17 | 8,124 | 12 |
| Ludlow, VT | $0.61 | $0.00 – $39.09 | 8,127 | 5 |
| Lake View, IA | $0.77 | $0.01 – $16.75 | 8,129 | 3 |
| Calera, AL | $159.27 | $0.00 – $546.43 | 8,130 | 12 |
| Westley, CA | $3.41 | $0.00 – $3.44 | 8,131 | 2 |
| Lake Grove, NY | $72.02 | $0.00 – $157.75 | 8,135 | 16 |
| Red Cloud, NE | $57.04 | $26.58 – $120.16 | 8,138 | 8 |
| Vail, AZ | $32.08 | $0.04 – $135.00 | 8,140 | 13 |
| Walker, MI | $53.94 | $48.02 – $56.53 | 8,141 | 3 |
| Palos Verdes Estates, CA | $24.89 | $1.15 – $180.08 | 8,149 | 4 |
| Tipton, IA | $6.72 | $0.12 – $32.53 | 8,150 | 5 |
| Eustis, FL | $12.57 | $0.00 – $58.63 | 8,152 | 13 |
| Loretto, TN | $32.36 | $0.00 – $33.47 | 8,153 | 4 |
| Mercer Island, WA | $23.98 | $1.01 – $91.67 | 8,153 | 16 |
| Emmaus, PA | $45.73 | $37.03 – $49.76 | 8,167 | 11 |
| Madill, OK | $74.07 | $55.14 – $75.60 | 8,167 | 3 |
| Slippery Rock, PA | $38.37 | $27.88 – $40.91 | 8,170 | 7 |
| Newtown Square, PA | $56.18 | $1.20 – $79.15 | 8,172 | 13 |
| Bryans Road, MD | $80.65 | $28.17 – $84.40 | 8,175 | 2 |
| Tunica, MS | $179.65 | $18.26 – $428.27 | 8,179 | 5 |
| Thomspon Falls, MT | $0.00 | $0.00 – $0.00 | 8,183 | 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.