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 |
|---|---|---|---|---|
| Century, FL | $33.82 | $13.73 – $43.66 | 9,639 | 6 |
| Port Lavaca, TX | $42.49 | $3.09 – $85.96 | 9,641 | 16 |
| Spencer, MA | $49.09 | $0.00 – $113.39 | 9,641 | 11 |
| Michie, TN | $29.80 | $29.79 – $31.50 | 9,641 | 2 |
| Watchung, NJ | $24.33 | $4.30 – $126.89 | 9,650 | 8 |
| Mt. Pocono, PA | $44.89 | $20.55 – $47.09 | 9,655 | 5 |
| Cazenoviz, NY | $41.56 | $35.46 – $51.74 | 9,665 | 3 |
| Narberth, PA | $48.54 | $0.00 – $89.02 | 9,665 | 9 |
| San Luis, CO | $158.39 | $156.36 – $167.33 | 9,667 | 2 |
| Laurelton, NY | $61.46 | $16.67 – $77.51 | 9,672 | 7 |
| Hallstead, PA | $42.17 | $0.00 – $71.19 | 9,675 | 5 |
| Delco, NC | $74.14 | $56.90 – $94.51 | 9,676 | 3 |
| Bolingbroook, IL | $51.41 | $51.41 – $51.41 | 9,680 | 1 |
| Herreid, SD | $45.46 | $25.42 – $45.50 | 9,683 | 2 |
| Collinsville, MS | $53.98 | $5.60 – $123.12 | 9,684 | 5 |
| Heppner, OR | $41.50 | $4.14 – $112.43 | 9,685 | 6 |
| War, WV | $27.53 | $12.37 – $57.50 | 9,699 | 3 |
| New Fairfield, CT | $58.72 | $16.31 – $187.48 | 9,703 | 10 |
| Kingston Springs, TN | $24.99 | $22.90 – $29.94 | 9,712 | 2 |
| Levitown, PR | $1.26 | $1.26 – $1.26 | 9,713 | 1 |
| Huntington, MA | $5.38 | $4.98 – $9.93 | 9,715 | 2 |
| Mansfield, PA | $28.72 | $0.00 – $76.95 | 9,731 | 11 |
| Alvaton, KY | $16.19 | $16.19 – $16.19 | 9,732 | 1 |
| Montgomery, IN | $53.77 | $39.09 – $61.29 | 9,738 | 4 |
| N Syracuse, NY | $41.11 | $0.84 – $71.92 | 9,738 | 7 |
| Chouteau, OK | $148.41 | $120.01 – $595.63 | 9,746 | 2 |
| Richand, WA | $74.05 | $74.05 – $74.05 | 9,753 | 1 |
| Gravois Mills, MO | $72.40 | $49.22 – $91.95 | 9,753 | 7 |
| Arden Hills, MN | $74.11 | $55.52 – $98.12 | 9,755 | 20 |
| Anthony, KS | $199.70 | $1.55 – $681.15 | 9,758 | 9 |
| Saint James, MN | $51.33 | $41.86 – $84.12 | 9,763 | 9 |
| Varnville, SC | $59.92 | $36.47 – $67.62 | 9,764 | 7 |
| Glenwood, MN | $142.46 | $0.73 – $217.74 | 9,774 | 18 |
| Auburndale, FL | $44.43 | $10.37 – $173.10 | 9,775 | 10 |
| Irving, NY | $88.36 | $33.89 – $703.61 | 9,778 | 13 |
| Waimea, HI | $106.15 | $58.64 – $158.73 | 9,780 | 9 |
| Lumberton, MS | $102.20 | $27.33 – $128.79 | 9,780 | 4 |
| Bellbrook, OH | $49.43 | $27.03 – $60.11 | 9,792 | 6 |
| Mora, NM | $107.48 | $41.83 – $153.84 | 9,801 | 4 |
| Fayette, MO | $56.69 | $16.63 – $150.54 | 9,807 | 10 |
| Fort Washington, PA | $30.12 | $3.99 – $121.63 | 9,815 | 15 |
| Vansant, VA | $45.18 | $28.63 – $55.33 | 9,815 | 5 |
| Lakehurst, NJ | $46.25 | $0.00 – $47.90 | 9,817 | 3 |
| W Babylon, NY | $72.42 | $72.42 – $72.42 | 9,818 | 1 |
| Pelican Rapids, MN | $68.49 | $40.01 – $101.56 | 9,821 | 7 |
| Cheltenham, PA | $45.68 | $24.20 – $46.72 | 9,821 | 2 |
| East Windsor, CT | $43.85 | $42.65 – $59.60 | 9,826 | 3 |
| Buckley, MI | $4.76 | $4.76 – $4.76 | 9,827 | 1 |
| Somers, CT | $35.81 | $20.40 – $68.00 | 9,829 | 5 |
| Black Mountain, NC | $55.19 | $19.43 – $73.06 | 9,831 | 16 |
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.