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 |
|---|---|---|---|---|
| Fredonia, KS | $48.07 | $7.66 – $74.12 | 22,948 | 10 |
| Kitty Hawk, NC | $57.07 | $33.88 – $66.89 | 22,960 | 11 |
| Hereford, AZ | $16.03 | $0.00 – $49.14 | 22,973 | 3 |
| Belmont, NH | $49.41 | $24.07 – $76.73 | 22,981 | 13 |
| Coloma, MI | $28.70 | $0.67 – $78.08 | 22,987 | 4 |
| Ada, OH | $45.94 | $0.38 – $79.85 | 22,999 | 10 |
| Pendleton, IN | $59.92 | $10.13 – $86.90 | 23,012 | 15 |
| Worthington, IN | $50.41 | $33.81 – $91.94 | 23,015 | 7 |
| Fairbury, NE | $58.86 | $24.54 – $151.38 | 23,024 | 14 |
| Crab Orchard, KY | $20.93 | $12.53 – $49.65 | 23,030 | 5 |
| Union, KY | $59.68 | $1.88 – $318.75 | 23,046 | 12 |
| Glen Head, NY | $82.01 | $31.81 – $150.04 | 23,059 | 10 |
| Clarksburg, MD | $92.23 | $72.05 – $119.44 | 23,071 | 7 |
| Jersey Shore, PA | $35.87 | $20.83 – $56.93 | 23,073 | 8 |
| Vinton, LA | $23.39 | $0.00 – $46.72 | 23,077 | 4 |
| Albion, ME | $2.86 | $1.15 – $67.73 | 23,091 | 3 |
| Beaver, UT | $37.36 | $1.41 – $67.81 | 23,094 | 9 |
| Ayer, MA | $47.34 | $18.71 – $143.20 | 23,101 | 16 |
| Oak View, CA | $11.26 | $5.63 – $64.65 | 23,117 | 4 |
| Onaway, MI | $22.47 | $21.82 – $25.58 | 23,122 | 2 |
| Belfair, WA | $38.11 | $0.00 – $69.53 | 23,152 | 12 |
| Grosse Pointe Woods, MI | $73.26 | $26.19 – $94.50 | 23,154 | 10 |
| Absecon, NJ | $91.26 | $12.41 – $127.99 | 23,160 | 10 |
| Liburn, GA | $68.74 | $68.74 – $68.74 | 23,168 | 1 |
| West Brookfield, MA | $49.18 | $45.47 – $52.90 | 23,174 | 3 |
| West End, NC | $50.40 | $17.64 – $74.38 | 23,175 | 14 |
| Baxter Springs, KS | $91.15 | $17.20 – $144.47 | 23,180 | 7 |
| Benton City, WA | $51.84 | $25.23 – $62.55 | 23,185 | 11 |
| Chittenango, NY | $72.69 | $41.30 – $104.41 | 23,187 | 7 |
| Basalt, CO | $137.19 | $38.93 – $224.01 | 23,190 | 10 |
| Sandwich, IL | $53.52 | $29.55 – $67.16 | 23,212 | 21 |
| Catlettsburg, KY | $33.07 | $29.45 – $36.35 | 23,225 | 6 |
| Saint Marys, GA | $61.04 | $31.55 – $102.06 | 23,245 | 12 |
| Jackson Hts, NY | $33.97 | $7.52 – $103.83 | 23,253 | 3 |
| Tabor City, NC | $32.06 | $2.65 – $54.67 | 23,256 | 7 |
| Grand Terrace, CA | $23.23 | $0.00 – $585.73 | 23,260 | 12 |
| Lahaina, HI | $82.11 | $19.11 – $281.20 | 23,261 | 20 |
| Mount Olive, NC | $35.39 | $2.45 – $71.84 | 23,264 | 12 |
| Chatham, LA | $0.16 | $0.00 – $0.52 | 23,266 | 3 |
| Broadway, VA | $50.38 | $40.02 – $76.07 | 23,274 | 13 |
| Cameron, NC | $64.88 | $48.67 – $68.88 | 23,293 | 9 |
| Somerset, MA | $42.94 | $18.35 – $56.47 | 23,297 | 9 |
| Lakeland, TN | $40.95 | $20.15 – $61.04 | 23,304 | 10 |
| Fairmont, NC | $39.76 | $27.93 – $55.50 | 23,326 | 6 |
| Mount Vernon, IA | $35.78 | $26.70 – $39.86 | 23,329 | 9 |
| Emmetsburg, IA | $4.53 | $0.00 – $101.98 | 23,342 | 9 |
| Elizabethtown, PA | $49.36 | $0.00 – $78.32 | 23,343 | 37 |
| Hunt Valley, MD | $63.41 | $2.59 – $268.13 | 23,343 | 28 |
| Ajo, AZ | $9.61 | $0.07 – $39.74 | 23,363 | 5 |
| Stephenville, TX | $34.54 | $12.75 – $84.04 | 23,363 | 27 |
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.