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 |
|---|---|---|---|---|
| Montross, VA | $55.76 | $36.10 – $66.38 | 21,483 | 5 |
| Cayce, SC | $75.01 | $40.47 – $300.00 | 21,508 | 15 |
| Clayton, NJ | $50.11 | $3.92 – $74.94 | 21,514 | 6 |
| Crawfordville, FL | $50.63 | $17.68 – $82.16 | 21,544 | 17 |
| East Grand Forks, MN | $73.54 | $43.27 – $119.25 | 21,546 | 21 |
| Riverwoods, IL | $58.38 | $58.11 – $72.51 | 21,557 | 3 |
| Madison, SD | $28.81 | $27.78 – $122.65 | 21,565 | 3 |
| Grand Coulee, WA | $62.74 | $48.95 – $88.02 | 21,571 | 14 |
| Jackson, LA | $37.55 | $18.06 – $62.65 | 21,576 | 5 |
| Sterling, MI | $14.65 | $12.51 – $76.94 | 21,598 | 2 |
| Gold Canyon, AZ | $77.74 | $0.00 – $101.36 | 21,607 | 8 |
| Monterey, TN | $29.16 | $5.15 – $43.19 | 21,621 | 10 |
| Gold River, CA | $11.04 | $0.00 – $50.89 | 21,634 | 5 |
| Uniondale, NY | $77.78 | $0.28 – $141.03 | 21,637 | 18 |
| Thorndale, PA | $37.70 | $1.38 – $62.30 | 21,638 | 13 |
| Edwards, CO | $148.85 | $0.00 – $238.32 | 21,698 | 26 |
| Andrews, TX | $33.27 | $2.67 – $47.55 | 21,716 | 6 |
| Alexandria Bay, NY | $112.33 | $33.73 – $236.42 | 21,741 | 9 |
| Daniels, WV | $15.87 | $0.00 – $70.87 | 21,745 | 12 |
| Spruce Pine, NC | $48.90 | $0.00 – $73.37 | 21,746 | 20 |
| Lakeway, TX | $20.03 | $1.75 – $95.24 | 21,789 | 16 |
| Bridgeport, TX | $38.20 | $31.61 – $55.28 | 21,790 | 6 |
| Belchertown, MA | $51.67 | $27.31 – $60.76 | 21,793 | 11 |
| Hutchinson, MN | $62.16 | $23.64 – $202.23 | 21,805 | 37 |
| Walled Lake, MI | $72.81 | $45.51 – $77.98 | 21,808 | 5 |
| Saltillo, MS | $48.37 | $0.00 – $99.46 | 21,839 | 15 |
| Kingstree, SC | $98.72 | $25.40 – $152.61 | 21,855 | 15 |
| Doylestown, PA | $46.44 | $0.00 – $123.16 | 21,859 | 50 |
| La Canada Flintridge, CA | $0.46 | $0.14 – $1.23 | 21,860 | 3 |
| Mount Ayr, IA | $6.12 | $0.01 – $344.04 | 21,871 | 9 |
| Brookville, NY | $35.22 | $8.12 – $152.40 | 21,876 | 4 |
| Beech Grove, IN | $60.10 | $1.47 – $96.51 | 21,893 | 12 |
| Monaca, PA | $42.36 | $0.94 – $102.04 | 21,912 | 18 |
| Madison Hts, MI | $41.58 | $41.52 – $49.38 | 21,932 | 2 |
| Woodstock, GA | $36.33 | $18.58 – $166.62 | 21,944 | 16 |
| Corry, PA | $7.57 | $0.00 – $42.26 | 21,945 | 15 |
| Atoka, OK | $147.92 | $0.04 – $642.89 | 21,948 | 13 |
| Staunton, IL | $1.48 | $0.00 – $322.05 | 21,961 | 5 |
| Harvard, IL | $32.48 | $0.00 – $65.66 | 21,963 | 7 |
| Weed, CA | $1.74 | $1.01 – $7.23 | 22,003 | 7 |
| Kennett Square, PA | $43.52 | $0.00 – $71.25 | 22,007 | 33 |
| Scott Afb, IL | $46.82 | $46.74 – $75.34 | 22,008 | 2 |
| Oneill, NE | $69.91 | $10.13 – $136.33 | 22,010 | 17 |
| Clendenin, WV | $10.99 | $0.00 – $14.30 | 22,015 | 4 |
| Brookhaven, GA | $72.10 | $10.98 – $98.19 | 22,033 | 17 |
| Beebe, AR | $32.78 | $0.58 – $45.34 | 22,044 | 8 |
| Brooklyn, MD | $110.05 | $2.64 – $215.29 | 22,053 | 8 |
| Mobridge, SD | $95.89 | $35.66 – $96.41 | 22,062 | 3 |
| Clayton, GA | $55.78 | $0.00 – $129.71 | 22,072 | 14 |
| Ashland, MS | $58.85 | $19.55 – $107.88 | 22,074 | 6 |
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.