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 |
|---|---|---|---|---|
| Spotsylvania, VA | $61.25 | $15.78 – $97.00 | 14,640 | 11 |
| Sissonville, WV | $14.70 | $14.70 – $14.70 | 14,646 | 1 |
| Hereford, TX | $38.85 | $0.00 – $82.27 | 14,647 | 8 |
| Seven Hills, OH | $56.34 | $4.37 – $104.96 | 14,662 | 5 |
| Mcleansboro, IL | $0.79 | $0.09 – $11.46 | 14,662 | 3 |
| Springfield, CO | $183.32 | $41.91 – $334.53 | 14,671 | 8 |
| Fairfield, ME | $31.53 | $0.00 – $89.99 | 14,677 | 17 |
| Fairfax, OK | $27.70 | $0.51 – $148.47 | 14,677 | 9 |
| Port Hadlock, WA | $77.88 | $7.29 – $143.36 | 14,695 | 6 |
| Lakeside, AZ | $53.15 | $17.74 – $87.48 | 14,699 | 16 |
| Apalachicola, FL | $132.19 | $10.89 – $214.07 | 14,705 | 6 |
| Aulander, NC | $33.26 | $32.88 – $33.42 | 14,709 | 3 |
| Peachtree City, GA | $61.02 | $0.00 – $76.96 | 14,710 | 16 |
| Gleason, TN | $31.66 | $23.98 – $44.47 | 14,715 | 3 |
| Freeport, TX | $60.35 | $0.00 – $91.61 | 14,740 | 12 |
| Crownpoint, NM | $132.42 | $10.21 – $334.77 | 14,752 | 8 |
| Belcamp, MD | $87.56 | $48.17 – $135.26 | 14,761 | 12 |
| Richford, VT | $6.36 | $0.00 – $97.78 | 14,776 | 11 |
| Saraland, AL | $46.46 | $1.70 – $64.21 | 14,780 | 11 |
| Peterstown, WV | $11.33 | $0.07 – $33.13 | 14,787 | 6 |
| Ellenton, FL | $66.30 | $33.41 – $67.72 | 14,797 | 3 |
| Quitman, MS | $57.44 | $11.34 – $123.30 | 14,802 | 11 |
| Wedowee, AL | $8.03 | $0.00 – $22.05 | 14,810 | 5 |
| Smithville, MO | $37.24 | $0.00 – $89.50 | 14,814 | 13 |
| Windsor Heights, IA | $43.09 | $29.61 – $76.76 | 14,824 | 12 |
| Red Bay, AL | $35.26 | $9.91 – $54.76 | 14,830 | 10 |
| Trenton, GA | $44.87 | $25.68 – $54.99 | 14,834 | 6 |
| Willow Creek, CA | $2.31 | $0.00 – $7.70 | 14,837 | 10 |
| Cassville, MO | $43.35 | $15.61 – $100.57 | 14,840 | 14 |
| Gorham, ME | $38.92 | $12.20 – $73.49 | 14,841 | 16 |
| Avon Lake, OH | $43.21 | $21.99 – $53.95 | 14,843 | 13 |
| Hartland, MI | $78.64 | $8.60 – $96.35 | 14,847 | 4 |
| Lake Odessa, MI | $17.79 | $7.72 – $73.01 | 14,850 | 3 |
| Jourdanton, TX | $34.31 | $7.37 – $38.28 | 14,853 | 7 |
| Columbia, IL | $52.32 | $30.60 – $86.63 | 14,855 | 17 |
| Watersmeet, MI | $21.93 | $21.43 – $51.89 | 14,857 | 5 |
| Monona, WI | $49.50 | $12.70 – $192.93 | 14,858 | 32 |
| Leakesville, MS | $67.10 | $0.00 – $101.45 | 14,859 | 12 |
| Sumner, WA | $46.02 | $9.06 – $58.23 | 14,859 | 10 |
| Mathiston, MS | $41.09 | $28.45 – $74.88 | 14,860 | 3 |
| Liberty, SC | $58.50 | $28.25 – $73.58 | 14,864 | 10 |
| Bath, ME | $30.97 | $4.13 – $116.11 | 14,865 | 21 |
| Richmond Hts, OH | $38.98 | $22.78 – $318.75 | 14,868 | 10 |
| Moon Twp, PA | $63.22 | $48.66 – $73.59 | 14,871 | 6 |
| Vienna, IL | $2.88 | $0.00 – $54.26 | 14,897 | 2 |
| Selah, WA | $50.10 | $31.61 – $72.26 | 14,903 | 15 |
| Augusta, KS | $53.99 | $18.14 – $163.06 | 14,905 | 13 |
| Newton Falls, OH | $33.28 | $3.22 – $47.76 | 14,915 | 6 |
| Garland, UT | $57.36 | $48.06 – $76.62 | 14,922 | 7 |
| New Market, MD | $66.65 | $37.24 – $103.36 | 14,932 | 6 |
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.