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 |
|---|---|---|---|---|
| Hillsboro, MO | $43.58 | $0.00 – $116.51 | 12,228 | 15 |
| Miller Place, NY | $97.71 | $36.18 – $111.62 | 12,230 | 12 |
| Sheffield, IL | $7.60 | $0.00 – $51.01 | 12,233 | 2 |
| North Windham, CT | $96.00 | $96.00 – $96.00 | 12,235 | 1 |
| Belleville, KS | $31.76 | $12.31 – $73.69 | 12,238 | 11 |
| North Riverside, IL | $49.77 | $0.00 – $84.29 | 12,241 | 15 |
| Coraopolis, PA | $48.98 | $32.97 – $75.54 | 12,245 | 10 |
| South Fallsburg, NY | $56.25 | $55.97 – $56.27 | 12,257 | 2 |
| Gregory, SD | $32.92 | $15.92 – $44.02 | 12,259 | 2 |
| Forest Park, GA | $58.36 | $8.66 – $98.83 | 12,263 | 8 |
| Rootstown, OH | $48.08 | $24.36 – $54.44 | 12,267 | 8 |
| Clearfield, KY | $36.83 | $36.83 – $36.83 | 12,269 | 1 |
| Northbridge, MA | $53.17 | $4.64 – $99.71 | 12,274 | 18 |
| Hillside, NJ | $61.21 | $7.99 – $115.71 | 12,276 | 9 |
| Churubusco, IN | $52.52 | $51.95 – $53.09 | 12,299 | 2 |
| West Yarmouth, MA | $55.52 | $3.68 – $68.26 | 12,304 | 11 |
| Wilkesboro, NC | $48.08 | $1.77 – $72.18 | 12,322 | 10 |
| Winterport, ME | $6.33 | $2.50 – $31.24 | 12,326 | 3 |
| Aspen, CO | $67.06 | $4.99 – $246.59 | 12,328 | 18 |
| Waterford, PA | $36.49 | $30.79 – $80.23 | 12,330 | 7 |
| Greenfield, TN | $37.34 | $33.53 – $46.60 | 12,338 | 3 |
| Litchfield, CT | $47.44 | $19.83 – $74.25 | 12,347 | 11 |
| Whitehall, MT | $73.65 | $63.18 – $87.95 | 12,357 | 4 |
| Radnor, PA | $54.90 | $8.64 – $89.69 | 12,357 | 21 |
| Scituate, MA | $31.55 | $6.35 – $112.17 | 12,358 | 17 |
| Cincinati, OH | $20.12 | $20.12 – $20.12 | 12,370 | 1 |
| Yanceyville, NC | $73.20 | $0.14 – $136.20 | 12,393 | 15 |
| Wilsonville, OR | $81.37 | $13.76 – $103.17 | 12,397 | 18 |
| Memphis, MO | $101.45 | $15.40 – $388.84 | 12,410 | 16 |
| Garner, IA | $7.32 | $0.01 – $48.94 | 12,412 | 7 |
| Jefferson, GA | $61.30 | $38.21 – $97.48 | 12,419 | 6 |
| Milbank, SD | $88.60 | $40.27 – $577.08 | 12,427 | 5 |
| Kahoka, MO | $29.59 | $0.00 – $66.32 | 12,428 | 7 |
| Webster, WI | $38.35 | $17.92 – $66.02 | 12,429 | 7 |
| Broadview Hts, OH | $46.52 | $30.84 – $52.69 | 12,435 | 9 |
| Lic, NY | $38.60 | $17.48 – $46.77 | 12,436 | 2 |
| Jefferson Valley, NY | $112.42 | $60.30 – $152.25 | 12,449 | 14 |
| Lexington Park, MD | $46.28 | $12.59 – $104.06 | 12,453 | 10 |
| Williamson, NY | $64.36 | $50.15 – $103.88 | 12,464 | 10 |
| Petersburg, AK | $80.40 | $13.34 – $178.03 | 12,469 | 9 |
| Trenton, KY | $29.64 | $22.13 – $46.18 | 12,470 | 4 |
| Richland, MS | $63.05 | $7.57 – $327.75 | 12,477 | 14 |
| Ashland, VA | $41.75 | $17.39 – $76.92 | 12,491 | 13 |
| Hicksville, OH | $36.24 | $21.43 – $55.29 | 12,493 | 9 |
| Kutztown, PA | $67.61 | $20.68 – $71.56 | 12,495 | 6 |
| Strasburg, VA | $66.47 | $58.14 – $84.92 | 12,503 | 8 |
| Eastport, ME | $2.42 | $1.67 – $427.41 | 12,508 | 3 |
| New Orleasns, LA | $35.25 | $35.25 – $35.25 | 12,517 | 1 |
| New Baltimore, MI | $56.72 | $56.72 – $56.72 | 12,526 | 1 |
| Honea Path, SC | $60.46 | $18.00 – $72.98 | 12,538 | 7 |
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.