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 |
|---|---|---|---|---|
| Prague, OK | $96.04 | $46.87 – $259.94 | 19,961 | 6 |
| Caneyville, KY | $30.50 | $24.47 – $32.55 | 19,967 | 4 |
| Ashland City, TN | $33.13 | $0.00 – $69.14 | 19,983 | 11 |
| Roosevelt, NY | $116.37 | $89.42 – $175.76 | 19,993 | 9 |
| Cicero, IN | $46.44 | $35.38 – $91.86 | 19,996 | 6 |
| Elwood, IN | $54.80 | $43.38 – $94.77 | 19,997 | 9 |
| Charleston, AR | $31.66 | $19.88 – $53.30 | 20,002 | 10 |
| Williamstown, MA | $137.69 | $16.77 – $353.99 | 20,015 | 13 |
| St. Joseph, MO | $50.30 | $27.60 – $83.11 | 20,020 | 14 |
| Columbiana, AL | $17.28 | $2.95 – $97.52 | 20,035 | 7 |
| Rogersville, MO | $66.39 | $10.96 – $152.69 | 20,038 | 24 |
| Deer Lodge, MT | $7.47 | $0.00 – $273.98 | 20,045 | 6 |
| Monmouth, OR | $74.68 | $7.67 – $593.65 | 20,048 | 11 |
| Weiser, ID | $3.81 | $0.00 – $16.81 | 20,055 | 12 |
| Pt Pleasant, WV | $43.58 | $16.07 – $71.31 | 20,060 | 10 |
| Belmont, MS | $45.39 | $0.00 – $84.70 | 20,071 | 14 |
| Creedmoor, NC | $46.22 | $0.00 – $70.43 | 20,077 | 24 |
| Crowley, TX | $38.62 | $5.53 – $38.93 | 20,081 | 6 |
| Chadbourn, NC | $47.25 | $3.34 – $65.90 | 20,098 | 4 |
| Luverne, MN | $55.72 | $2.52 – $94.78 | 20,129 | 15 |
| Oswego, IL | $47.39 | $15.57 – $86.24 | 20,145 | 24 |
| Sulphur, OK | $147.53 | $27.34 – $209.92 | 20,152 | 11 |
| Stuarts Draft, VA | $58.86 | $24.42 – $97.79 | 20,154 | 19 |
| Chelan, WA | $30.42 | $3.69 – $535.79 | 20,162 | 22 |
| Helotes, TX | $39.22 | $17.24 – $77.01 | 20,165 | 8 |
| North Ridgeville, OH | $50.29 | $28.98 – $76.41 | 20,165 | 14 |
| Middletown, NJ | $55.03 | $3.31 – $81.27 | 20,197 | 15 |
| Spencer, OK | $122.13 | $0.00 – $286.28 | 20,204 | 11 |
| Perham, MN | $50.85 | $30.03 – $143.89 | 20,208 | 29 |
| Zeeland, MI | $51.81 | $0.98 – $73.50 | 20,212 | 10 |
| Parachute, CO | $166.84 | $108.29 – $226.48 | 20,254 | 5 |
| Jay, FL | $25.77 | $0.24 – $28.93 | 20,261 | 5 |
| Chillicothe, MO | $69.88 | $26.31 – $124.05 | 20,263 | 23 |
| Point Reyes Station, CA | $6.25 | $1.70 – $44.60 | 20,270 | 10 |
| Coal City, IL | $43.77 | $38.74 – $61.74 | 20,271 | 7 |
| Arizona City, AZ | $76.56 | $5.52 – $102.92 | 20,305 | 6 |
| Basile, LA | $6.89 | $0.00 – $15.48 | 20,311 | 3 |
| Woodville, CA | $0.38 | $0.35 – $0.80 | 20,333 | 2 |
| Raytown, MO | $66.12 | $0.00 – $110.27 | 20,333 | 19 |
| Arlington, MA | $43.66 | $0.00 – $165.68 | 20,344 | 27 |
| Thornville, OH | $24.17 | $12.34 – $59.28 | 20,344 | 5 |
| Mcfarland, CA | $20.22 | $15.97 – $21.42 | 20,355 | 2 |
| Vassar, MI | $52.62 | $0.00 – $63.43 | 20,360 | 4 |
| Corvallis, MT | $27.17 | $0.00 – $82.37 | 20,382 | 2 |
| Rupert, ID | $12.63 | $0.00 – $75.44 | 20,388 | 21 |
| Mandan, ND | $101.17 | $38.41 – $147.74 | 20,389 | 21 |
| Hyde Park, NY | $80.91 | $44.89 – $125.84 | 20,404 | 16 |
| Emerson, NJ | $69.70 | $10.52 – $109.27 | 20,421 | 13 |
| Fort Thompson, SD | $422.59 | $162.34 – $487.06 | 20,425 | 2 |
| Colby, KS | $153.24 | $32.67 – $166.20 | 20,433 | 9 |
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.