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 |
|---|---|---|---|---|
| Rawlins, WY | $51.79 | $13.43 – $64.92 | 17,741 | 10 |
| Alva, OK | $144.70 | $62.95 – $550.43 | 17,760 | 11 |
| Hillsboro, WI | $76.89 | $17.72 – $97.14 | 17,764 | 17 |
| Arnold, MD | $109.42 | $19.01 – $220.51 | 17,765 | 24 |
| Central Square, NY | $79.54 | $15.66 – $116.17 | 17,777 | 8 |
| Mangilao, GU | $85.56 | $85.56 – $85.56 | 17,780 | 1 |
| California City, CA | $29.37 | $6.67 – $44.59 | 17,784 | 6 |
| Princeton Junction, NJ | $13.86 | $0.73 – $37.63 | 17,789 | 3 |
| Buhl, ID | $21.35 | $0.87 – $89.26 | 17,806 | 7 |
| Mt Prospect, IL | $42.07 | $15.63 – $61.81 | 17,809 | 13 |
| Lorton, VA | $62.71 | $15.60 – $86.68 | 17,810 | 16 |
| Triadelphia, WV | $41.18 | $15.64 – $117.52 | 17,811 | 9 |
| Sophia, WV | $4.62 | $0.00 – $40.06 | 17,828 | 6 |
| Bridgeview, IL | $59.75 | $55.47 – $66.42 | 17,853 | 4 |
| Melrose Pk, IL | $47.45 | $45.69 – $49.03 | 17,861 | 2 |
| South Milwaukee, WI | $36.57 | $23.11 – $163.72 | 17,862 | 17 |
| Carleton, MI | $2.84 | $2.33 – $164.67 | 17,870 | 2 |
| Groveland, FL | $48.62 | $23.24 – $120.09 | 17,875 | 8 |
| White Bluff, TN | $50.57 | $35.27 – $52.70 | 17,889 | 4 |
| Villas, NJ | $71.76 | $29.49 – $110.09 | 17,889 | 6 |
| Canal Fulton, OH | $47.92 | $23.82 – $83.48 | 17,893 | 9 |
| Wildwood, NJ | $5.06 | $0.00 – $9.96 | 17,907 | 4 |
| Villa Park, CA | $76.34 | $1.25 – $78.94 | 17,915 | 2 |
| Gassaway, WV | $12.97 | $3.60 – $47.38 | 17,921 | 4 |
| Niskayuna, NY | $67.00 | $5.17 – $135.14 | 17,927 | 27 |
| Mt Pleasant, TN | $49.18 | $12.47 – $52.72 | 17,929 | 7 |
| Greenbrier, AR | $36.96 | $19.49 – $321.53 | 17,935 | 13 |
| Sebastopol, MS | $73.72 | $47.94 – $108.04 | 17,937 | 10 |
| Chester, NY | $84.11 | $30.02 – $100.19 | 17,949 | 7 |
| Norton, MA | $45.70 | $1.19 – $63.52 | 17,959 | 11 |
| Hayden, ID | $57.34 | $0.00 – $167.23 | 17,979 | 21 |
| Caseyville, IL | $57.58 | $30.12 – $58.62 | 17,995 | 5 |
| Davis, OK | $85.28 | $78.07 – $103.16 | 18,003 | 8 |
| Unionville, CT | $50.49 | $18.67 – $86.77 | 18,009 | 9 |
| Indian Land, SC | $56.63 | $20.19 – $85.74 | 18,010 | 24 |
| Marion, MA | $50.78 | $35.00 – $99.95 | 18,023 | 8 |
| Plover, WI | $36.66 | $12.08 – $318.75 | 18,026 | 14 |
| Saugerties, NY | $98.25 | $59.62 – $135.87 | 18,032 | 14 |
| Bernie, MO | $52.43 | $2.41 – $97.74 | 18,034 | 4 |
| Old Tappan, NJ | $53.44 | $1.10 – $70.71 | 18,040 | 8 |
| Enon, OH | $44.63 | $43.60 – $48.24 | 18,045 | 3 |
| Hensley, AR | $32.49 | $0.00 – $43.58 | 18,050 | 9 |
| West Fargo, ND | $109.35 | $22.16 – $343.81 | 18,054 | 33 |
| Kenmore, NY | $72.88 | $23.81 – $119.57 | 18,060 | 27 |
| Leeds, MA | $70.85 | $0.00 – $106.21 | 18,078 | 13 |
| Baxley, GA | $71.66 | $15.69 – $893.07 | 18,081 | 7 |
| Oakwood, OH | $59.66 | $3.16 – $318.75 | 18,093 | 15 |
| Clarksville, VA | $50.77 | $36.03 – $74.94 | 18,103 | 9 |
| Madison, NC | $54.14 | $16.00 – $64.74 | 18,104 | 11 |
| Moravia, NY | $63.45 | $44.54 – $76.58 | 18,107 | 3 |
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.