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 |
|---|---|---|---|---|
| Otterbein, IN | $76.09 | $20.86 – $101.56 | 10,387 | 6 |
| Mc Laughlin, SD | $105.06 | $105.06 – $105.06 | 10,390 | 1 |
| Madison, VA | $59.04 | $13.45 – $67.40 | 10,397 | 9 |
| Eatonville, WA | $52.71 | $19.31 – $56.48 | 10,397 | 6 |
| Buena Vista, CO | $101.51 | $42.16 – $153.77 | 10,398 | 9 |
| Hesperia, MI | $5.52 | $1.05 – $6.74 | 10,413 | 2 |
| Moose Lake, MN | $64.95 | $21.00 – $77.49 | 10,414 | 17 |
| Coal Valley, IL | $17.18 | $11.27 – $41.27 | 10,417 | 2 |
| Hot Springs National Park, AR | $84.15 | $18.13 – $581.91 | 10,418 | 9 |
| Fallston, MD | $97.70 | $40.26 – $127.39 | 10,432 | 9 |
| Fountain Hills, AZ | $53.11 | $0.00 – $81.55 | 10,435 | 13 |
| Brookland, AR | $35.53 | $30.13 – $44.87 | 10,435 | 5 |
| Gunnison, MS | $38.17 | $38.17 – $38.17 | 10,444 | 1 |
| Dover, AR | $29.66 | $21.49 – $39.68 | 10,444 | 5 |
| Oak Forest, IL | $45.28 | $11.74 – $134.86 | 10,446 | 14 |
| Bloomfield Township, MI | $59.14 | $34.25 – $68.87 | 10,449 | 5 |
| Jamesburg, NJ | $22.04 | $3.30 – $22.38 | 10,455 | 3 |
| Johnsonville, SC | $61.31 | $28.86 – $67.29 | 10,455 | 3 |
| Trafford, PA | $73.13 | $49.20 – $86.01 | 10,457 | 6 |
| Albany, CA | $9.72 | $0.00 – $75.93 | 10,461 | 19 |
| Blacksville, WV | $12.73 | $0.03 – $23.82 | 10,461 | 2 |
| Naranja, FL | $11.63 | $9.20 – $13.66 | 10,470 | 2 |
| Hawesville, KY | $40.79 | $31.63 – $43.54 | 10,471 | 5 |
| Medley, FL | $3.12 | $1.50 – $10.14 | 10,476 | 4 |
| Vernon, TX | $31.01 | $4.69 – $119.13 | 10,477 | 16 |
| Dulles, VA | $72.58 | $9.22 – $94.26 | 10,488 | 10 |
| Fox Point, WI | $47.29 | $32.75 – $69.35 | 10,490 | 9 |
| Biscoe, NC | $52.65 | $17.55 – $79.67 | 10,492 | 5 |
| Bedford, PA | $10.58 | $0.00 – $47.35 | 10,494 | 7 |
| Chesterland, OH | $41.39 | $17.01 – $119.72 | 10,496 | 15 |
| Smithfield, VA | $55.96 | $16.30 – $68.80 | 10,506 | 10 |
| Clatskanie, OR | $31.43 | $29.53 – $33.03 | 10,511 | 2 |
| Wind Gap, PA | $42.50 | $33.28 – $50.94 | 10,513 | 11 |
| Mount Pleasant, TN | $50.74 | $50.74 – $50.74 | 10,516 | 1 |
| Tsaile, AZ | $104.61 | $11.31 – $114.18 | 10,517 | 5 |
| Margaretville, NY | $81.52 | $64.34 – $116.71 | 10,517 | 7 |
| Afton, OK | $97.81 | $1.05 – $224.34 | 10,527 | 5 |
| Post, TX | $15.52 | $0.00 – $43.86 | 10,534 | 4 |
| Sigourney, IA | $20.70 | $0.04 – $115.24 | 10,539 | 9 |
| Questa, NM | $135.10 | $55.07 – $142.90 | 10,549 | 3 |
| West Roxbury, MA | $40.10 | $1.23 – $128.78 | 10,553 | 27 |
| Cooper City, FL | $112.86 | $2.72 – $497.75 | 10,555 | 8 |
| Mcintosh, AL | $10.09 | $0.00 – $21.42 | 10,556 | 3 |
| Kilgore, TX | $45.01 | $6.80 – $75.87 | 10,560 | 12 |
| Higganum, CT | $49.87 | $18.50 – $66.16 | 10,560 | 8 |
| Fort Benton, MT | $0.87 | $0.00 – $48.96 | 10,560 | 5 |
| Pacific Palisades, CA | $14.24 | $0.00 – $100.48 | 10,562 | 12 |
| Charleston, MO | $82.53 | $15.47 – $248.56 | 10,578 | 9 |
| Winthrop, MA | $36.21 | $16.31 – $64.94 | 10,587 | 9 |
| Union City, PA | $25.74 | $0.00 – $45.35 | 10,595 | 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.