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 |
|---|---|---|---|---|
| Cedar Grove, NJ | $28.88 | $1.41 – $76.09 | 15,642 | 16 |
| East Point, GA | $44.11 | $4.51 – $117.15 | 15,649 | 20 |
| La Mesa, NM | $125.08 | $125.08 – $125.08 | 15,660 | 1 |
| Jonesport, ME | $58.52 | $58.28 – $76.78 | 15,661 | 3 |
| Gilford, NH | $31.12 | $14.68 – $107.83 | 15,671 | 16 |
| White Pigeon, MI | $6.32 | $4.11 – $42.26 | 15,678 | 2 |
| Bourne, MA | $65.74 | $9.50 – $119.03 | 15,688 | 18 |
| Richmond Heights, MO | $61.85 | $28.64 – $96.35 | 15,718 | 16 |
| Kayenta, AZ | $579.95 | $14.07 – $630.99 | 15,722 | 9 |
| Lodi, NJ | $49.09 | $22.89 – $80.13 | 15,733 | 10 |
| Carrollton, MO | $62.93 | $13.37 – $119.79 | 15,734 | 13 |
| Katonah, NY | $66.53 | $0.00 – $212.43 | 15,734 | 23 |
| Boscobel, WI | $84.55 | $17.66 – $127.21 | 15,739 | 20 |
| Fort Branch, IN | $54.80 | $43.42 – $68.71 | 15,743 | 9 |
| Midland Park, NJ | $87.65 | $22.02 – $132.54 | 15,771 | 9 |
| Charlestown, NH | $6.53 | $0.00 – $39.19 | 15,772 | 5 |
| Millry, AL | $30.08 | $4.55 – $95.69 | 15,780 | 2 |
| Humboldt, KS | $17.11 | $0.00 – $62.43 | 15,782 | 4 |
| Deerfield, IL | $52.89 | $8.54 – $122.06 | 15,806 | 25 |
| Grandview Heights, OH | $60.36 | $24.82 – $64.75 | 15,807 | 11 |
| East Norwich, NY | $14.94 | $2.04 – $20.30 | 15,809 | 2 |
| Warrenton, OR | $55.31 | $0.00 – $80.43 | 15,816 | 15 |
| Hugo, CO | $38.83 | $0.00 – $110.27 | 15,821 | 11 |
| Delhi, CA | $4.89 | $2.59 – $21.11 | 15,822 | 4 |
| New Waterford, OH | $22.88 | $22.88 – $22.88 | 15,842 | 1 |
| Montesano, WA | $54.39 | $20.70 – $84.51 | 15,848 | 9 |
| Northfolk, MA | $65.45 | $65.45 – $65.45 | 15,850 | 1 |
| Neillsville, WI | $85.82 | $0.00 – $148.83 | 15,852 | 14 |
| Willow Springs, MO | $58.48 | $41.43 – $77.31 | 15,854 | 8 |
| Jb Andrews, MD | $37.13 | $3.75 – $667.63 | 15,856 | 8 |
| Swedesboro, NJ | $48.26 | $0.00 – $69.37 | 15,859 | 13 |
| Smithfield, PA | $35.36 | $26.61 – $56.17 | 15,862 | 6 |
| Stratford, OK | $78.29 | $3.86 – $91.09 | 15,869 | 4 |
| Rossford, OH | $44.96 | $29.06 – $51.81 | 15,871 | 10 |
| Kettle Falls, WA | $43.19 | $10.12 – $51.84 | 15,872 | 6 |
| Crystal, MN | $72.12 | $3.96 – $103.07 | 15,876 | 30 |
| Surfside Beach, SC | $55.83 | $27.75 – $98.56 | 15,896 | 16 |
| Granger, WA | $45.38 | $16.91 – $84.82 | 15,905 | 4 |
| Lindsay, OK | $15.16 | $0.12 – $84.76 | 15,919 | 8 |
| Rincon, GA | $50.94 | $26.24 – $101.53 | 15,925 | 7 |
| Phoenix, OR | $63.85 | $0.98 – $77.79 | 15,928 | 4 |
| Houston, MO | $70.26 | $15.50 – $100.53 | 15,937 | 17 |
| Keysville, VA | $54.42 | $54.42 – $54.42 | 15,952 | 1 |
| Stanley, ND | $10.98 | $7.54 – $48.34 | 15,953 | 4 |
| Caledonia, MI | $61.24 | $10.81 – $69.65 | 15,954 | 6 |
| Bremen, GA | $58.77 | $0.00 – $62.40 | 15,956 | 7 |
| Garrett, IN | $62.45 | $55.10 – $68.30 | 15,958 | 5 |
| Fort Fairfield, ME | $50.47 | $3.35 – $63.72 | 15,961 | 5 |
| Gorham, NH | $11.40 | $0.00 – $152.12 | 15,961 | 14 |
| East Waterboro, ME | $43.51 | $21.72 – $71.91 | 15,962 | 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.