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 |
|---|---|---|---|---|
| Everson, WA | $32.21 | $24.36 – $58.68 | 15,300 | 7 |
| Eureka, IL | $16.87 | $0.29 – $66.75 | 15,313 | 5 |
| Franklin Park, IL | $48.20 | $24.11 – $63.99 | 15,315 | 7 |
| Missouri Valley, IA | $8.37 | $0.00 – $128.85 | 15,323 | 11 |
| Midfield, AL | $197.39 | $0.00 – $224.48 | 15,340 | 7 |
| Columbus, MT | $35.65 | $0.00 – $92.19 | 15,359 | 3 |
| Long Prairie, MN | $203.88 | $46.19 – $259.62 | 15,363 | 14 |
| Hackberry, LA | $19.02 | $0.00 – $19.25 | 15,372 | 2 |
| Airmont, NY | $108.00 | $50.58 – $143.42 | 15,375 | 14 |
| Section, AL | $0.35 | $0.00 – $0.86 | 15,388 | 4 |
| Allendale, MI | $29.35 | $0.92 – $62.33 | 15,389 | 3 |
| Plainfield, VT | $14.63 | $0.00 – $58.29 | 15,389 | 11 |
| Buffalo, MO | $83.70 | $31.07 – $111.40 | 15,395 | 9 |
| Smithsburg, MD | $87.00 | $59.04 – $100.22 | 15,398 | 10 |
| Booneville, AR | $44.53 | $20.50 – $639.62 | 15,398 | 15 |
| Monmouth, ME | $14.90 | $2.03 – $57.60 | 15,412 | 8 |
| Neodesha, KS | $131.65 | $22.95 – $235.89 | 15,416 | 7 |
| Koloa, HI | $39.33 | $13.82 – $123.57 | 15,423 | 8 |
| Hondo, TX | $11.97 | $0.00 – $120.17 | 15,425 | 12 |
| Planada, CA | $1.05 | $0.00 – $1.06 | 15,434 | 3 |
| West Union, SC | $61.92 | $58.08 – $64.00 | 15,435 | 3 |
| Damascus, OR | $61.18 | $56.64 – $108.87 | 15,457 | 4 |
| Smithfield, KY | $36.83 | $36.23 – $189.66 | 15,458 | 2 |
| Waterville, OH | $45.94 | $0.00 – $64.70 | 15,470 | 11 |
| Freeport, ME | $46.92 | $19.13 – $60.22 | 15,477 | 10 |
| Marmora, NJ | $41.58 | $11.18 – $59.21 | 15,478 | 13 |
| Oblong, IL | $0.01 | $0.01 – $0.01 | 15,479 | 1 |
| Green Cove Springs, FL | $49.71 | $6.77 – $124.94 | 15,493 | 10 |
| Hughesville, PA | $39.37 | $35.30 – $48.78 | 15,497 | 3 |
| Sesser, IL | $6.45 | $0.01 – $59.46 | 15,499 | 3 |
| Tremonton, UT | $43.39 | $3.78 – $69.57 | 15,503 | 12 |
| St. Charles, VA | $43.92 | $12.81 – $51.18 | 15,510 | 3 |
| Mercerville, NJ | $49.31 | $26.53 – $126.76 | 15,519 | 12 |
| Hildebran, NC | $51.28 | $44.72 – $63.54 | 15,527 | 6 |
| Middleton, TN | $31.47 | $27.60 – $40.26 | 15,530 | 4 |
| Toledo, OR | $72.04 | $48.09 – $83.72 | 15,535 | 6 |
| Daleville, IN | $59.87 | $56.33 – $65.61 | 15,546 | 4 |
| Baldwin, LA | $14.43 | $0.00 – $32.26 | 15,552 | 3 |
| Mc Daniels, KY | $32.04 | $17.53 – $32.87 | 15,560 | 3 |
| Bagley, MN | $94.84 | $0.00 – $149.57 | 15,586 | 11 |
| Delta Junction, AK | $96.68 | $28.97 – $374.43 | 15,589 | 4 |
| Iron City, TN | $50.66 | $50.66 – $50.66 | 15,595 | 1 |
| Middleton, WI | $27.14 | $0.16 – $124.64 | 15,597 | 36 |
| La Grange, TX | $32.21 | $11.50 – $76.04 | 15,612 | 10 |
| Derby, KS | $43.00 | $17.74 – $93.94 | 15,615 | 14 |
| Eastsound, WA | $21.67 | $10.72 – $82.62 | 15,627 | 10 |
| Rogue River, OR | $25.96 | $0.99 – $98.27 | 15,633 | 7 |
| Shipshewana, IN | $49.29 | $24.58 – $62.68 | 15,633 | 7 |
| Montpelier, OH | $40.84 | $9.19 – $43.41 | 15,636 | 8 |
| Camino, CA | $19.15 | $19.15 – $19.15 | 15,640 | 1 |
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.