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 |
|---|---|---|---|---|
| Brodheadsville, PA | $40.53 | $1.06 – $75.53 | 9,452 | 10 |
| Sardis City, AL | $60.16 | $0.00 – $61.97 | 9,456 | 2 |
| Fayetteville, PA | $45.47 | $21.87 – $62.81 | 9,462 | 7 |
| Wescosville, PA | $0.33 | $0.33 – $0.33 | 9,462 | 1 |
| Raymond, WA | $38.90 | $7.98 – $65.87 | 9,463 | 7 |
| Lexington, MO | $22.76 | $7.96 – $88.29 | 9,467 | 5 |
| Bainbridge, OH | $34.30 | $4.96 – $36.72 | 9,468 | 4 |
| Whitewater, WI | $30.18 | $13.68 – $43.72 | 9,473 | 12 |
| Mccordsville, IN | $65.03 | $21.15 – $73.69 | 9,476 | 9 |
| Lenox, IA | $0.40 | $0.00 – $46.48 | 9,484 | 4 |
| Wildwood, FL | $33.10 | $1.24 – $45.89 | 9,486 | 5 |
| West Carrollton, OH | $83.34 | $43.60 – $91.71 | 9,488 | 3 |
| Alum Creek, WV | $69.90 | $47.54 – $81.62 | 9,490 | 4 |
| Ontario, NY | $68.85 | $65.44 – $75.85 | 9,497 | 4 |
| San Lorenzo, CA | $27.78 | $25.00 – $54.06 | 9,500 | 3 |
| Cle Elum, WA | $49.10 | $28.65 – $63.54 | 9,500 | 8 |
| La Marque, TX | $84.04 | $63.46 – $98.21 | 9,503 | 4 |
| Paynesville, MN | $158.01 | $3.70 – $188.10 | 9,506 | 13 |
| Moab, UT | $62.16 | $7.13 – $245.81 | 9,506 | 17 |
| Republic, MO | $63.92 | $1.15 – $90.29 | 9,514 | 10 |
| Akwesasne, NY | $339.57 | $178.32 – $513.72 | 9,522 | 6 |
| Nashville, IN | $64.53 | $45.87 – $78.25 | 9,531 | 5 |
| Rich Square, NC | $27.42 | $0.00 – $28.12 | 9,533 | 3 |
| Garrison, NY | $117.26 | $45.82 – $189.27 | 9,534 | 5 |
| Ilwaco, WA | $55.86 | $30.84 – $66.07 | 9,537 | 10 |
| Brownsville, OR | $70.65 | $18.21 – $82.62 | 9,537 | 3 |
| Zapata, TX | $21.75 | $0.00 – $39.04 | 9,540 | 8 |
| Holtsville, NY | $42.51 | $41.45 – $81.32 | 9,548 | 3 |
| Valley Springs, CA | $10.98 | $2.19 – $29.83 | 9,551 | 5 |
| Woodstown, NJ | $113.88 | $7.40 – $195.64 | 9,554 | 6 |
| Chefornak, AK | $339.00 | $0.00 – $449.45 | 9,555 | 5 |
| Goshen, CA | $4.74 | $1.67 – $4.82 | 9,564 | 2 |
| Prairie City, IA | $25.69 | $0.00 – $34.72 | 9,565 | 5 |
| Wright Patterson Afb, OH | $47.55 | $19.18 – $73.10 | 9,566 | 13 |
| Watsontown, PA | $37.70 | $37.70 – $37.70 | 9,566 | 1 |
| Hot Springs Village, AR | $30.90 | $0.00 – $36.64 | 9,570 | 8 |
| Gloster, MS | $85.06 | $34.23 – $114.40 | 9,578 | 4 |
| Calvert City, KY | $36.90 | $24.08 – $42.47 | 9,588 | 4 |
| Tracy, MN | $82.72 | $50.47 – $173.52 | 9,589 | 5 |
| Norton, KS | $135.98 | $135.98 – $135.98 | 9,592 | 1 |
| Ambler, PA | $53.96 | $0.00 – $68.04 | 9,601 | 8 |
| Independence, OR | $36.97 | $10.23 – $117.95 | 9,605 | 6 |
| Cordell, OK | $125.64 | $96.18 – $127.08 | 9,607 | 4 |
| House Springs, MO | $55.10 | $44.54 – $111.62 | 9,614 | 3 |
| Rochester, WA | $57.11 | $12.57 – $116.31 | 9,618 | 7 |
| Warsaw, NC | $26.80 | $0.20 – $41.39 | 9,620 | 4 |
| Wayne, NE | $50.29 | $29.99 – $62.53 | 9,623 | 5 |
| Hayes, LA | $39.81 | $39.81 – $39.81 | 9,625 | 1 |
| Inchelium, WA | $33.60 | $0.13 – $54.00 | 9,628 | 6 |
| Greenville, WI | $38.71 | $30.20 – $46.37 | 9,630 | 8 |
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.