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 |
|---|---|---|---|---|
| Sudbury, MA | $30.35 | $1.81 – $193.68 | 17,028 | 18 |
| Southhaven, MS | $74.23 | $74.23 – $74.23 | 17,033 | 1 |
| Morris, MN | $53.53 | $1.11 – $162.81 | 17,036 | 25 |
| Solomons, MD | $106.73 | $46.23 – $174.82 | 17,044 | 15 |
| Shorewood, WI | $24.90 | $10.21 – $62.32 | 17,044 | 9 |
| Gooding, ID | $54.11 | $0.27 – $459.42 | 17,049 | 17 |
| Weber City, VA | $43.01 | $14.83 – $55.20 | 17,055 | 5 |
| Monroe Township, NJ | $49.18 | $7.92 – $123.62 | 17,064 | 12 |
| Wyoming, MN | $58.34 | $38.70 – $83.74 | 17,064 | 37 |
| Wixom, MI | $78.65 | $78.65 – $78.65 | 17,064 | 1 |
| Parkesburg, PA | $35.06 | $8.66 – $48.58 | 17,066 | 8 |
| Sellersville, PA | $43.90 | $0.00 – $119.76 | 17,081 | 52 |
| Beverly Hills, FL | $34.68 | $0.00 – $80.93 | 17,087 | 15 |
| Hertford, NC | $34.68 | $29.68 – $70.82 | 17,099 | 3 |
| Orcutt, CA | $47.85 | $1.95 – $48.10 | 17,105 | 3 |
| Milbridge, ME | $36.90 | $23.79 – $37.71 | 17,126 | 4 |
| Kealakekua, HI | $91.20 | $0.00 – $259.08 | 17,127 | 16 |
| Virginia Bch, VA | $71.60 | $56.65 – $90.63 | 17,148 | 3 |
| Belmont, MA | $44.31 | $0.00 – $237.18 | 17,151 | 24 |
| Amargosa Valley, NV | $54.88 | $0.00 – $70.31 | 17,158 | 4 |
| Bexley, OH | $35.68 | $16.21 – $134.90 | 17,165 | 5 |
| Clay Center, KS | $110.48 | $13.11 – $132.32 | 17,171 | 10 |
| Beaverton, MI | $14.48 | $11.20 – $41.48 | 17,188 | 3 |
| Toxey, AL | $47.44 | $44.89 – $79.60 | 17,192 | 3 |
| Hanover, IN | $52.20 | $29.18 – $86.50 | 17,199 | 7 |
| Whitesville, WV | $28.94 | $0.00 – $56.47 | 17,214 | 3 |
| Winthrop, ME | $38.13 | $25.99 – $77.24 | 17,234 | 9 |
| Honokaa, HI | $155.80 | $0.00 – $252.70 | 17,234 | 15 |
| Fort Riley, KS | $52.60 | $0.00 – $477.40 | 17,248 | 15 |
| Buda, TX | $48.77 | $3.49 – $329.42 | 17,254 | 16 |
| Holbrook, AZ | $43.95 | $0.04 – $91.96 | 17,256 | 6 |
| Perry, OK | $109.16 | $75.45 – $132.22 | 17,256 | 4 |
| Saint Robert, MO | $72.06 | $30.41 – $93.50 | 17,298 | 11 |
| White Bear Lake, MN | $59.58 | $15.29 – $77.86 | 17,302 | 35 |
| Crete, NE | $98.48 | $10.59 – $130.00 | 17,307 | 18 |
| Fort Sumner, NM | $96.99 | $31.95 – $139.59 | 17,308 | 5 |
| Sea Girt, NJ | $61.84 | $3.35 – $120.26 | 17,309 | 11 |
| Russells Point, OH | $33.76 | $0.71 – $46.58 | 17,315 | 7 |
| Bellevue, KY | $41.29 | $20.91 – $50.62 | 17,325 | 11 |
| Forest City, IA | $25.76 | $22.48 – $31.06 | 17,334 | 8 |
| Arbuckle, CA | $5.58 | $0.00 – $21.53 | 17,341 | 4 |
| Richmond Heights, OH | $44.89 | $1.44 – $112.12 | 17,344 | 22 |
| Sardis, MS | $47.80 | $16.69 – $61.23 | 17,346 | 7 |
| Greenbrier, TN | $43.81 | $12.17 – $56.48 | 17,348 | 8 |
| Newcastle, OK | $83.84 | $53.30 – $371.99 | 17,360 | 9 |
| Waconia, MN | $52.39 | $19.83 – $238.65 | 17,361 | 59 |
| Waterbury, VT | $12.93 | $0.00 – $35.31 | 17,363 | 11 |
| Eagle Grove, IA | $1.23 | $0.13 – $38.22 | 17,366 | 3 |
| Chatham, VA | $43.33 | $17.07 – $76.10 | 17,368 | 7 |
| Hinton, OK | $91.82 | $69.78 – $113.87 | 17,368 | 5 |
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.