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 |
|---|---|---|---|---|
| Interlochen, MI | $68.23 | $68.23 – $68.23 | 18,121 | 1 |
| Canyonville, OR | $56.78 | $45.02 – $128.55 | 18,124 | 3 |
| Grain Valley, MO | $72.86 | $55.50 – $101.24 | 18,124 | 7 |
| Leander, TX | $40.21 | $15.78 – $57.02 | 18,131 | 16 |
| Galloway, OH | $46.82 | $40.37 – $54.22 | 18,140 | 6 |
| Simsbury, CT | $24.63 | $4.06 – $64.75 | 18,148 | 14 |
| Dexter, ME | $17.37 | $10.80 – $40.32 | 18,148 | 5 |
| Cedar Crest, NM | $82.68 | $67.74 – $141.51 | 18,161 | 8 |
| Piedmont, AL | $25.28 | $1.16 – $45.57 | 18,169 | 8 |
| Leoma, TN | $32.74 | $29.47 – $38.68 | 18,169 | 2 |
| Clinton, AR | $30.50 | $20.15 – $34.98 | 18,169 | 10 |
| Pen Argyl, PA | $29.67 | $2.76 – $54.94 | 18,178 | 5 |
| Hanover Park, IL | $28.40 | $0.00 – $76.53 | 18,190 | 12 |
| Waynesville, OH | $87.30 | $35.60 – $96.01 | 18,208 | 5 |
| Tuckahoe, NY | $56.85 | $38.51 – $105.18 | 18,219 | 9 |
| Watkinsville, GA | $45.15 | $0.00 – $97.36 | 18,221 | 26 |
| Mc Murray, PA | $51.30 | $6.57 – $93.86 | 18,263 | 32 |
| Catoosa, OK | $85.92 | $18.45 – $144.30 | 18,266 | 9 |
| Caruthersville, MO | $65.30 | $0.00 – $86.90 | 18,276 | 9 |
| Four Oaks, NC | $55.39 | $19.64 – $60.92 | 18,277 | 7 |
| Middletown, PA | $58.52 | $32.35 – $89.71 | 18,291 | 20 |
| Albertson, NY | $71.27 | $35.35 – $139.22 | 18,307 | 4 |
| Townshend, VT | $14.13 | $5.10 – $35.15 | 18,316 | 12 |
| Kenmore, WA | $51.29 | $14.43 – $106.21 | 18,324 | 22 |
| Ripley, OH | $26.85 | $21.64 – $29.64 | 18,337 | 2 |
| Marriottsville, MD | $73.94 | $36.68 – $98.20 | 18,341 | 5 |
| Seven Fields, PA | $41.44 | $4.59 – $108.18 | 18,355 | 12 |
| Destrehan, LA | $43.06 | $24.54 – $56.38 | 18,357 | 11 |
| Standish, MI | $18.37 | $14.17 – $52.21 | 18,360 | 4 |
| Eleanor, WV | $5.93 | $0.01 – $54.55 | 18,374 | 7 |
| Washington, UT | $65.30 | $65.30 – $65.30 | 18,395 | 1 |
| Macon, MO | $63.92 | $0.00 – $102.70 | 18,396 | 18 |
| Windom, MN | $79.77 | $21.05 – $236.46 | 18,396 | 16 |
| Broadalbin, NY | $76.53 | $59.64 – $100.44 | 18,401 | 6 |
| Conrad, MT | $25.68 | $0.00 – $110.62 | 18,413 | 5 |
| Farmers Branch, TX | $30.20 | $3.64 – $54.86 | 18,434 | 11 |
| Big Bear Lake, CA | $31.97 | $0.00 – $424.50 | 18,442 | 16 |
| Annville, PA | $42.23 | $0.00 – $65.91 | 18,490 | 20 |
| Taylorsville, MS | $43.79 | $8.37 – $103.13 | 18,514 | 9 |
| Acworth, GA | $60.18 | $7.92 – $130.01 | 18,535 | 19 |
| Thomson, GA | $55.02 | $0.00 – $82.29 | 18,536 | 8 |
| Northfield, IL | $87.74 | $21.07 – $121.65 | 18,543 | 12 |
| Cliffwood, NJ | $37.85 | $31.48 – $60.91 | 18,551 | 3 |
| Sidney, NE | $90.58 | $16.76 – $179.03 | 18,559 | 20 |
| Zion Crossroads, VA | $46.30 | $29.06 – $73.42 | 18,562 | 18 |
| Hot Springs, SD | $79.11 | $0.00 – $82.30 | 18,596 | 6 |
| Middleburg, PA | $43.65 | $35.71 – $64.86 | 18,596 | 3 |
| Estill Springs, TN | $47.25 | $39.00 – $64.09 | 18,600 | 4 |
| Centerton, AR | $44.40 | $23.41 – $173.35 | 18,603 | 16 |
| Jamestown, OH | $35.66 | $4.44 – $91.58 | 18,604 | 15 |
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.