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 |
|---|---|---|---|---|
| College Place, WA | $47.25 | $31.47 – $61.58 | 14,320 | 6 |
| Thomaston, CT | $46.44 | $30.23 – $56.26 | 14,322 | 8 |
| Willisburg, KY | $18.09 | $16.22 – $21.48 | 14,343 | 2 |
| Melissa, TX | $65.94 | $0.00 – $67.60 | 14,351 | 6 |
| De Witt, IA | $35.83 | $0.00 – $48.36 | 14,351 | 12 |
| Farr West, UT | $39.80 | $17.44 – $53.25 | 14,353 | 8 |
| Amherst, VA | $55.58 | $22.09 – $86.66 | 14,356 | 14 |
| Potomac Falls, VA | $52.35 | $22.18 – $78.52 | 14,357 | 12 |
| Mantua, OH | $55.32 | $44.74 – $61.43 | 14,359 | 4 |
| Macy, NE | $58.71 | $18.01 – $481.93 | 14,373 | 6 |
| Hudsonville, MI | $56.32 | $44.54 – $100.43 | 14,375 | 5 |
| Victor, NY | $59.75 | $0.12 – $90.24 | 14,379 | 27 |
| Nettleton, MS | $52.06 | $20.72 – $105.27 | 14,380 | 8 |
| Boonville, CA | $5.18 | $1.50 – $7.53 | 14,384 | 4 |
| Island Park, NY | $55.12 | $36.88 – $96.92 | 14,391 | 6 |
| Acoma, NM | $62.45 | $0.00 – $605.32 | 14,404 | 20 |
| Marengo, IN | $47.46 | $45.81 – $73.09 | 14,405 | 3 |
| Marshall, NC | $232.33 | $0.00 – $354.35 | 14,416 | 10 |
| Carrollton, AL | $73.87 | $0.00 – $197.36 | 14,417 | 8 |
| Grethel, KY | $29.90 | $5.93 – $32.08 | 14,423 | 4 |
| Citronelle, AL | $16.02 | $0.00 – $53.84 | 14,424 | 5 |
| John Day, OR | $37.33 | $9.89 – $100.47 | 14,429 | 12 |
| Rustburg, VA | $61.05 | $16.40 – $650.38 | 14,432 | 10 |
| South Whitley, IN | $53.78 | $45.53 – $75.35 | 14,434 | 5 |
| Mcclellan, CA | $7.69 | $0.09 – $70.83 | 14,439 | 6 |
| Gainesville, TX | $45.15 | $4.95 – $254.67 | 14,452 | 20 |
| Parksley, VA | $46.12 | $30.90 – $76.96 | 14,479 | 7 |
| Baker, MT | $14.21 | $0.00 – $18.96 | 14,483 | 2 |
| Sabina, OH | $46.46 | $34.46 – $47.90 | 14,485 | 3 |
| Mamers, NC | $33.93 | $33.93 – $33.93 | 14,497 | 1 |
| Pipestone, MN | $29.38 | $3.57 – $40.96 | 14,499 | 10 |
| Richboro, PA | $28.61 | $5.84 – $42.25 | 14,524 | 13 |
| Horsham, PA | $18.45 | $0.01 – $115.32 | 14,526 | 38 |
| Boyne City, MI | $27.61 | $27.58 – $43.85 | 14,543 | 2 |
| North Palm Beach, FL | $71.03 | $4.83 – $136.73 | 14,547 | 13 |
| Mount Angel, OR | $82.96 | $53.09 – $97.63 | 14,551 | 6 |
| Barling, AR | $39.07 | $24.79 – $590.14 | 14,555 | 9 |
| Greenfield, IA | $12.30 | $0.15 – $91.27 | 14,572 | 5 |
| Richmond, MO | $51.00 | $14.76 – $81.97 | 14,575 | 11 |
| Guttenberg, IA | $4.06 | $0.05 – $27.72 | 14,583 | 6 |
| Jber, AK | $93.98 | $31.75 – $688.61 | 14,591 | 16 |
| Bellmead, TX | $40.00 | $27.72 – $83.04 | 14,598 | 3 |
| Maiden, NC | $38.73 | $20.46 – $49.80 | 14,598 | 9 |
| Blanchester, OH | $37.48 | $25.39 – $47.54 | 14,602 | 7 |
| Sistersville, WV | $37.81 | $0.15 – $65.02 | 14,614 | 7 |
| Wartrace, TN | $30.02 | $24.86 – $32.51 | 14,616 | 2 |
| Counce, TN | $24.32 | $14.36 – $45.64 | 14,617 | 4 |
| Comanche, TX | $33.45 | $15.44 – $38.48 | 14,627 | 4 |
| Ceredo, WV | $60.25 | $14.42 – $66.77 | 14,634 | 4 |
| Spotsylvania, VA | $61.25 | $15.78 – $97.00 | 14,640 | 11 |
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.