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 |
|---|---|---|---|---|
| Amenia, NY | $82.17 | $50.64 – $116.24 | 19,009 | 7 |
| Bristol, IN | $52.16 | $47.63 – $60.53 | 19,021 | 5 |
| Jeremiah, KY | $33.07 | $33.07 – $33.07 | 19,023 | 1 |
| Enola, PA | $48.87 | $1.15 – $79.78 | 19,032 | 46 |
| Mcdowell, KY | $25.63 | $23.77 – $29.97 | 19,032 | 2 |
| Cumberland, WI | $30.88 | $17.82 – $101.00 | 19,034 | 16 |
| Delta, UT | $74.35 | $42.07 – $86.62 | 19,040 | 11 |
| Williamston, SC | $58.70 | $46.35 – $66.61 | 19,043 | 5 |
| Jeannette, PA | $57.56 | $13.15 – $66.40 | 19,046 | 10 |
| Blythewood, SC | $73.66 | $64.04 – $240.97 | 19,050 | 6 |
| Pawcatuck, CT | $37.08 | $0.94 – $80.92 | 19,065 | 14 |
| Overland, MO | $76.90 | $2.77 – $117.90 | 19,066 | 7 |
| Henrietta, NY | $70.22 | $31.64 – $81.42 | 19,073 | 20 |
| Caruthers, CA | $2.29 | $0.00 – $3.34 | 19,076 | 4 |
| Ridgefield, NJ | $36.71 | $12.46 – $98.84 | 19,094 | 8 |
| Gardiner, ME | $38.47 | $33.39 – $56.42 | 19,109 | 11 |
| Arlington, TN | $46.53 | $15.42 – $63.98 | 19,110 | 13 |
| W Springfield, MA | $69.25 | $42.16 – $87.96 | 19,125 | 5 |
| Dundee, FL | $47.59 | $1.50 – $61.19 | 19,132 | 9 |
| Rogers, MN | $72.98 | $52.13 – $116.99 | 19,143 | 27 |
| Forsyth, MO | $42.71 | $12.75 – $105.34 | 19,157 | 8 |
| Royston, GA | $53.56 | $17.20 – $61.67 | 19,163 | 5 |
| Bensenville, IL | $25.53 | $0.00 – $55.55 | 19,165 | 9 |
| Baxter, KY | $22.15 | $22.15 – $22.15 | 19,176 | 1 |
| Plymouth, WI | $31.92 | $19.72 – $39.70 | 19,178 | 25 |
| North East, MD | $80.42 | $10.78 – $116.48 | 19,193 | 11 |
| Orofino, ID | $29.74 | $4.44 – $167.68 | 19,194 | 18 |
| Ruther Glen, VA | $60.66 | $28.43 – $102.54 | 19,222 | 5 |
| Pocomoke City, MD | $116.72 | $0.00 – $174.76 | 19,225 | 13 |
| Plantersville, MS | $42.93 | $6.58 – $54.72 | 19,226 | 6 |
| South Hadley, MA | $51.74 | $17.56 – $80.56 | 19,228 | 26 |
| Copley, OH | $35.48 | $19.50 – $64.83 | 19,247 | 12 |
| Medina, NY | $54.52 | $27.88 – $255.01 | 19,250 | 14 |
| Estes Park, CO | $131.76 | $43.56 – $603.43 | 19,256 | 19 |
| Commerce Twp, MI | $62.09 | $0.00 – $210.20 | 19,265 | 10 |
| Waterford, WI | $33.87 | $5.27 – $60.40 | 19,269 | 22 |
| Chilton, WI | $39.17 | $13.50 – $39.76 | 19,273 | 9 |
| Coalmont, TN | $34.48 | $24.29 – $37.47 | 19,273 | 2 |
| Spindale, NC | $48.32 | $0.00 – $81.76 | 19,278 | 14 |
| Rising Sun, IN | $52.19 | $30.34 – $58.66 | 19,282 | 4 |
| Atlanta, MI | $11.12 | $11.12 – $11.12 | 19,289 | 1 |
| Bassett, VA | $55.19 | $40.90 – $77.95 | 19,295 | 7 |
| Hubbard, OH | $39.49 | $18.96 – $55.68 | 19,307 | 11 |
| Lily, KY | $17.06 | $16.59 – $34.37 | 19,308 | 2 |
| East Amherst, NY | $65.51 | $22.21 – $167.76 | 19,326 | 37 |
| Elgin, SC | $53.77 | $27.47 – $78.31 | 19,338 | 10 |
| Smyrna, DE | $49.90 | $0.00 – $97.88 | 19,352 | 22 |
| Moosic, PA | $45.32 | $0.65 – $96.22 | 19,360 | 13 |
| Iron River, WI | $14.20 | $2.32 – $44.99 | 19,363 | 6 |
| Fort Sill, OK | $93.09 | $0.00 – $629.25 | 19,372 | 20 |
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.