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 |
|---|---|---|---|---|
| Dewey, AZ | $53.51 | $37.35 – $69.82 | 22,531 | 12 |
| Burgaw, NC | $55.67 | $45.18 – $90.18 | 22,535 | 9 |
| Hermantown, MN | $72.57 | $15.23 – $132.53 | 22,568 | 22 |
| Port Richey, FL | $30.40 | $0.00 – $227.91 | 22,579 | 28 |
| Lutcher, LA | $29.16 | $12.89 – $203.21 | 22,586 | 11 |
| Simmesport, LA | $3.99 | $0.00 – $77.21 | 22,602 | 3 |
| Abbeville, AL | $37.90 | $0.00 – $219.16 | 22,603 | 7 |
| Valdese, NC | $29.38 | $13.71 – $579.27 | 22,619 | 11 |
| Fraser, MI | $65.00 | $14.97 – $67.17 | 22,622 | 3 |
| Mt Pleasant, PA | $40.87 | $27.47 – $89.60 | 22,637 | 22 |
| Bethel Park, PA | $45.34 | $14.80 – $60.56 | 22,637 | 34 |
| Brenham, TX | $42.99 | $0.00 – $77.34 | 22,642 | 36 |
| Hilton Head, SC | $88.64 | $25.61 – $238.70 | 22,646 | 17 |
| Newfane, NY | $38.28 | $4.93 – $56.39 | 22,683 | 7 |
| Riverdale, GA | $67.80 | $12.41 – $135.26 | 22,699 | 29 |
| Lake Ariel, PA | $21.26 | $0.00 – $490.30 | 22,706 | 7 |
| Grandville, MI | $60.76 | $41.64 – $78.34 | 22,713 | 10 |
| Redwood Valley, CA | $0.03 | $0.00 – $2.77 | 22,730 | 2 |
| Scotia, CA | $0.70 | $0.70 – $0.70 | 22,744 | 1 |
| Lisle, IL | $58.88 | $13.41 – $263.54 | 22,747 | 35 |
| Evansdale, IA | $39.67 | $26.85 – $44.99 | 22,758 | 9 |
| Dacula, GA | $65.56 | $4.58 – $120.59 | 22,761 | 20 |
| Southport, CT | $56.06 | $0.00 – $88.66 | 22,765 | 10 |
| Bruceton, TN | $34.33 | $29.63 – $34.63 | 22,781 | 2 |
| Montgomery Village, MD | $82.52 | $53.68 – $130.85 | 22,782 | 11 |
| Columbus, NC | $32.27 | $1.27 – $59.09 | 22,785 | 20 |
| Mcloud, OK | $391.13 | $84.42 – $648.93 | 22,786 | 11 |
| Saint Ignace, MI | $43.70 | $14.10 – $82.37 | 22,796 | 5 |
| Bushnell, FL | $33.63 | $0.00 – $156.67 | 22,797 | 13 |
| Cloquet, MN | $157.03 | $8.54 – $719.00 | 22,819 | 56 |
| Ra;Eigh, NC | $72.21 | $72.21 – $72.21 | 22,819 | 1 |
| Antlers, OK | $121.47 | $1.89 – $644.70 | 22,820 | 10 |
| Eau Claire, MI | $2.16 | $2.16 – $2.16 | 22,827 | 1 |
| River Edge, NJ | $55.01 | $25.50 – $111.84 | 22,838 | 7 |
| Charlotte Hall, MD | $86.66 | $39.38 – $116.44 | 22,854 | 15 |
| Kuna, ID | $48.81 | $1.41 – $90.95 | 22,855 | 18 |
| Duncan, SC | $74.67 | $12.03 – $191.68 | 22,865 | 15 |
| Uvalde, TX | $42.10 | $0.00 – $744.23 | 22,869 | 22 |
| Bishopville, SC | $127.02 | $31.77 – $326.65 | 22,870 | 12 |
| East Jordan, MI | $24.61 | $24.61 – $24.61 | 22,871 | 1 |
| Upper Arlington, OH | $45.46 | $4.13 – $276.00 | 22,874 | 37 |
| Greensboro, AL | $46.99 | $0.00 – $216.37 | 22,877 | 11 |
| Fort Thomas, KY | $55.75 | $16.88 – $124.28 | 22,879 | 22 |
| Morris Plains, NJ | $55.49 | $0.07 – $105.61 | 22,889 | 16 |
| Hernando, MS | $38.95 | $9.08 – $85.99 | 22,890 | 18 |
| Bloomfield, IA | $4.29 | $0.00 – $151.59 | 22,907 | 12 |
| Konawa, OK | $110.28 | $0.00 – $618.83 | 22,910 | 9 |
| Lancaster, MA | $35.85 | $23.54 – $127.98 | 22,920 | 13 |
| Salem, UT | $56.78 | $34.84 – $141.75 | 22,922 | 26 |
| Augusta, KY | $32.79 | $27.29 – $43.78 | 22,927 | 7 |
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.