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 |
|---|---|---|---|---|
| Union City, MI | $1.38 | $1.38 – $1.38 | 8,185 | 1 |
| Medway, ME | $1.45 | $1.45 – $1.45 | 8,188 | 1 |
| Ocean Park, WA | $36.35 | $0.00 – $63.56 | 8,192 | 8 |
| Farmington, PA | $35.22 | $32.43 – $38.11 | 8,196 | 4 |
| Chrisman, IL | $1.56 | $0.00 – $28.69 | 8,209 | 4 |
| Tulalip, WA | $47.93 | $5.98 – $68.15 | 8,210 | 12 |
| Smackover, AR | $37.94 | $27.85 – $44.23 | 8,212 | 4 |
| Boonville, MO | $81.39 | $52.26 – $111.44 | 8,215 | 9 |
| Atwood, IL | $13.78 | $0.02 – $52.55 | 8,221 | 4 |
| Covington Township, PA | $38.99 | $34.43 – $39.66 | 8,222 | 3 |
| Atlantic Beach, NY | $33.07 | $32.60 – $126.75 | 8,224 | 2 |
| North Sioux City, SD | $26.48 | $0.05 – $74.28 | 8,227 | 5 |
| Chester, MT | $3.90 | $0.00 – $70.37 | 8,229 | 2 |
| Canyon, TX | $35.06 | $1.46 – $116.66 | 8,232 | 11 |
| Quitman, TX | $267.04 | $32.31 – $320.61 | 8,235 | 6 |
| Arlington, VT | $11.13 | $0.19 – $29.89 | 8,244 | 7 |
| Schoharie, NY | $113.87 | $42.81 – $137.46 | 8,252 | 4 |
| Alsip, IL | $46.95 | $39.58 – $66.05 | 8,256 | 4 |
| Cornell, WI | $38.98 | $21.04 – $63.67 | 8,258 | 5 |
| Elkmont, AL | $46.79 | $30.99 – $70.85 | 8,262 | 5 |
| Crosby, MN | $75.92 | $0.00 – $188.85 | 8,267 | 39 |
| Suffield, CT | $41.96 | $16.64 – $58.27 | 8,276 | 6 |
| Pine Grove, PA | $35.22 | $16.05 – $40.33 | 8,278 | 4 |
| Fulton, IL | $46.20 | $29.30 – $53.13 | 8,282 | 5 |
| University Hts, OH | $45.02 | $25.74 – $60.02 | 8,282 | 3 |
| Concrete, WA | $29.15 | $14.26 – $47.29 | 8,283 | 4 |
| Russiaville, IN | $53.58 | $34.62 – $61.28 | 8,291 | 9 |
| Miami Springs, FL | $58.14 | $52.76 – $58.97 | 8,292 | 2 |
| Plentywood, MT | $5.45 | $0.00 – $48.91 | 8,296 | 3 |
| Mountt Vernon, NY | $41.34 | $41.34 – $41.34 | 8,297 | 1 |
| Closter, NJ | $34.49 | $14.63 – $90.99 | 8,299 | 6 |
| Blountsville, AL | $4.77 | $0.00 – $73.31 | 8,301 | 4 |
| Mount Pleasant, NC | $58.19 | $53.85 – $60.42 | 8,304 | 9 |
| Farmersville, TX | $34.46 | $25.92 – $61.17 | 8,309 | 4 |
| Rose Hill, NC | $14.75 | $0.00 – $28.24 | 8,313 | 5 |
| Bedford, KY | $43.23 | $10.06 – $326.11 | 8,316 | 5 |
| India Harbor Bch, FL | $68.52 | $68.52 – $68.52 | 8,317 | 1 |
| Pecos, TX | $37.00 | $0.00 – $45.98 | 8,329 | 9 |
| Crivitz, WI | $40.59 | $29.67 – $69.28 | 8,330 | 6 |
| Aptos, CA | $3.85 | $0.00 – $82.47 | 8,336 | 17 |
| Ashville, OH | $41.76 | $33.39 – $67.37 | 8,337 | 6 |
| Danforth, ME | $3.63 | $3.63 – $3.63 | 8,337 | 1 |
| Ft. Sill, OK | $0.39 | $0.04 – $0.42 | 8,338 | 2 |
| Bimble, KY | $29.33 | $19.41 – $29.41 | 8,343 | 2 |
| East Berlin, PA | $54.82 | $22.54 – $97.01 | 8,351 | 10 |
| Crossett, AR | $29.86 | $19.48 – $58.97 | 8,355 | 10 |
| Port Washington, NY | $68.04 | $2.69 – $195.48 | 8,355 | 15 |
| New Haven, KY | $28.23 | $23.16 – $33.73 | 8,355 | 2 |
| Darlington, WI | $70.78 | $10.96 – $135.94 | 8,356 | 16 |
| Sweetwater, FL | $36.74 | $17.49 – $39.64 | 8,361 | 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.