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 |
|---|---|---|---|---|
| Mystic, CT | $30.16 | $0.00 – $83.42 | 20,454 | 29 |
| Bedford Hills, NY | $54.64 | $0.13 – $192.64 | 20,455 | 9 |
| Alexandria, IN | $50.06 | $23.29 – $88.98 | 20,482 | 11 |
| Franklin, WV | $12.40 | $0.00 – $20.63 | 20,502 | 12 |
| Hope Valley, RI | $43.70 | $38.02 – $60.75 | 20,518 | 11 |
| West Union, IA | $12.89 | $0.00 – $65.04 | 20,528 | 13 |
| Delmar, NY | $61.37 | $25.85 – $81.83 | 20,533 | 23 |
| Marion, LA | $0.03 | $0.02 – $0.05 | 20,536 | 3 |
| Kildeer, IL | $49.93 | $47.29 – $122.26 | 20,539 | 9 |
| Westport, MA | $35.95 | $1.38 – $89.51 | 20,545 | 15 |
| Hastings, MN | $68.85 | $19.44 – $148.86 | 20,566 | 37 |
| Gladstone, MO | $46.00 | $1.75 – $94.01 | 20,579 | 14 |
| Sumner, MS | $48.92 | $12.13 – $95.39 | 20,585 | 5 |
| Hardwick, VT | $12.22 | $0.00 – $119.96 | 20,593 | 12 |
| Waynesville, MO | $60.54 | $19.21 – $140.56 | 20,605 | 10 |
| Milan, MO | $60.63 | $8.86 – $81.92 | 20,607 | 7 |
| Knightstown, IN | $43.80 | $41.43 – $45.16 | 20,619 | 3 |
| Mancelona, MI | $64.87 | $10.58 – $77.44 | 20,625 | 3 |
| Sellersburg, IN | $38.97 | $26.10 – $54.66 | 20,628 | 6 |
| Mckeesport, PA | $53.03 | $16.90 – $188.63 | 20,632 | 40 |
| Spencerport, NY | $65.08 | $24.19 – $88.92 | 20,639 | 14 |
| Wrentham, MA | $51.30 | $37.94 – $85.50 | 20,641 | 6 |
| Lamar, MO | $67.93 | $5.89 – $145.99 | 20,662 | 15 |
| Boonsboro, MD | $89.76 | $7.42 – $108.36 | 20,675 | 8 |
| Okolona, MS | $48.13 | $0.00 – $117.26 | 20,675 | 7 |
| Lucasville, OH | $46.07 | $45.23 – $46.78 | 20,692 | 2 |
| Exmore, VA | $46.70 | $43.03 – $56.72 | 20,700 | 3 |
| Commerce, GA | $52.35 | $14.52 – $84.82 | 20,705 | 7 |
| Brownfield, TX | $32.60 | $2.88 – $33.29 | 20,715 | 4 |
| Champlin, MN | $88.95 | $36.23 – $178.62 | 20,756 | 33 |
| La Vergne, TN | $58.97 | $15.40 – $471.11 | 20,776 | 7 |
| Penitas, TX | $25.61 | $25.61 – $25.61 | 20,810 | 1 |
| Moriarty, NM | $88.27 | $75.40 – $148.11 | 20,817 | 5 |
| Chatham, IL | $57.16 | $26.97 – $76.12 | 20,817 | 21 |
| Ottawa, OH | $40.61 | $15.71 – $82.72 | 20,833 | 12 |
| Brunswick, OH | $39.06 | $18.05 – $103.50 | 20,847 | 32 |
| Columbia, PA | $51.44 | $5.66 – $113.82 | 20,852 | 11 |
| Newport, NH | $108.85 | $92.40 – $196.53 | 20,867 | 6 |
| Dodgeville, WI | $77.64 | $7.50 – $132.90 | 20,893 | 25 |
| Milford, NH | $34.31 | $0.00 – $71.94 | 20,901 | 27 |
| Fort Belvoir, VA | $67.69 | $7.55 – $614.93 | 20,910 | 26 |
| York, ME | $38.37 | $10.01 – $63.30 | 20,911 | 47 |
| Autaugaville, AL | $83.88 | $0.00 – $85.35 | 20,922 | 3 |
| Harrisville, WV | $12.60 | $0.01 – $65.06 | 20,922 | 8 |
| Moneta, VA | $61.07 | $29.13 – $69.53 | 20,928 | 12 |
| Hayesville, NC | $43.59 | $0.00 – $165.70 | 20,932 | 10 |
| Wiinnsboro, LA | $0.00 | $0.00 – $0.00 | 20,941 | 1 |
| El Rito, NM | $18.79 | $7.47 – $120.30 | 20,957 | 4 |
| Warren, AR | $31.49 | $0.00 – $44.41 | 20,976 | 17 |
| Middletown, MD | $103.07 | $0.00 – $124.61 | 20,990 | 8 |
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.