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 |
|---|---|---|---|---|
| Hulbert, OK | $11.76 | $0.00 – $74.14 | 16,641 | 7 |
| Ferndale, CA | $0.72 | $0.00 – $0.85 | 16,667 | 4 |
| Wakefield, MA | $40.99 | $1.73 – $63.68 | 16,694 | 24 |
| Middlefield, OH | $44.52 | $29.49 – $57.27 | 16,698 | 10 |
| Gary, WV | $21.75 | $2.43 – $109.72 | 16,706 | 6 |
| Lancaster, TX | $25.69 | $0.03 – $59.37 | 16,710 | 8 |
| Hogansburg, NY | $289.04 | $14.42 – $510.24 | 16,712 | 9 |
| Hominy, OK | $46.72 | $0.81 – $97.46 | 16,721 | 5 |
| Fairfax, SC | $104.36 | $10.44 – $187.39 | 16,723 | 13 |
| International Falls, MN | $140.04 | $27.69 – $176.00 | 16,727 | 15 |
| Lambertville, MI | $42.72 | $11.63 – $67.41 | 16,733 | 17 |
| Bedford, MA | $45.31 | $0.16 – $123.08 | 16,750 | 26 |
| Marlborough, CT | $58.71 | $12.96 – $85.66 | 16,752 | 13 |
| Holiday, FL | $39.34 | $2.44 – $67.35 | 16,760 | 10 |
| Petersburg, IL | $1.58 | $0.75 – $46.84 | 16,767 | 2 |
| Orange City, IA | $33.14 | $9.58 – $39.88 | 16,767 | 22 |
| Fellsmere, FL | $28.90 | $12.11 – $70.90 | 16,782 | 8 |
| Artesia, CA | $6.94 | $2.49 – $76.87 | 16,786 | 8 |
| Salmon, ID | $27.39 | $0.00 – $76.10 | 16,787 | 13 |
| Rushville, NY | $53.74 | $7.49 – $81.74 | 16,795 | 11 |
| Grovetown, GA | $46.01 | $8.73 – $71.40 | 16,817 | 6 |
| Jay, OK | $60.31 | $5.47 – $133.83 | 16,818 | 9 |
| Eastland, TX | $30.62 | $1.83 – $40.37 | 16,831 | 9 |
| Citrus Springs, FL | $36.59 | $24.63 – $53.49 | 16,837 | 4 |
| Robbinsville, NJ | $27.93 | $13.29 – $159.44 | 16,858 | 15 |
| Grandville, SC | $77.96 | $77.96 – $77.96 | 16,860 | 1 |
| Billerica, MA | $58.64 | $2.43 – $88.11 | 16,863 | 12 |
| Rocky Point, NY | $66.61 | $49.30 – $117.69 | 16,896 | 8 |
| Mc Bain, MI | $8.09 | $5.18 – $13.82 | 16,907 | 2 |
| Hale, MI | $23.83 | $16.64 – $45.80 | 16,909 | 3 |
| Prairie Du Sac, WI | $55.47 | $11.60 – $61.20 | 16,911 | 12 |
| Granite Falls, MN | $48.13 | $22.56 – $107.63 | 16,911 | 8 |
| Nanticoke, PA | $37.09 | $2.50 – $54.93 | 16,913 | 10 |
| Mitchellville, MD | $64.21 | $0.00 – $133.46 | 16,915 | 9 |
| Reedsport, OR | $53.05 | $13.94 – $64.39 | 16,920 | 15 |
| Rowland, NC | $47.88 | $40.67 – $65.66 | 16,922 | 4 |
| Tumon, GU | $84.03 | $84.03 – $84.03 | 16,927 | 1 |
| Monticello, IA | $4.76 | $0.01 – $52.02 | 16,934 | 6 |
| Lackawanna, NY | $43.72 | $0.00 – $95.24 | 16,934 | 12 |
| Arabi, LA | $0.52 | $0.00 – $54.95 | 16,944 | 2 |
| Roodhouse, IL | $0.04 | $0.02 – $0.04 | 16,947 | 2 |
| Summerfield, NC | $64.74 | $14.83 – $94.63 | 16,977 | 14 |
| Wray, CO | $58.38 | $7.13 – $120.53 | 16,982 | 14 |
| South Webster, OH | $48.49 | $48.24 – $48.84 | 16,984 | 2 |
| Russell, KS | $101.87 | $18.64 – $151.88 | 16,984 | 10 |
| Newbern, TN | $31.98 | $15.42 – $40.20 | 16,989 | 5 |
| Thiensville, WI | $29.75 | $26.06 – $43.95 | 16,993 | 5 |
| Maryland Heights, MO | $58.77 | $12.91 – $101.73 | 17,000 | 22 |
| Saint Ignatius, MT | $4.05 | $2.18 – $59.80 | 17,010 | 4 |
| Oliver Springs, TN | $30.44 | $7.84 – $44.60 | 17,022 | 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.