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 |
|---|---|---|---|---|
| Lake Hopatcong, NJ | $75.88 | $13.58 – $80.21 | 23,842 | 4 |
| Cheneyville, LA | $0.00 | $0.00 – $0.00 | 23,845 | 2 |
| Burlington City, NJ | $31.04 | $0.01 – $85.89 | 23,855 | 5 |
| Golden Valley, MN | $91.89 | $31.15 – $426.99 | 23,869 | 61 |
| Vernon, AL | $51.50 | $0.00 – $209.09 | 23,876 | 11 |
| Randolph, NJ | $46.34 | $13.15 – $89.93 | 23,894 | 19 |
| Hazel Green, AL | $82.28 | $30.54 – $108.15 | 23,933 | 10 |
| Ny, NY | $77.64 | $13.58 – $166.46 | 23,948 | 27 |
| Macomb, MI | $70.35 | $11.53 – $112.02 | 23,956 | 19 |
| Norwalk, IA | $37.16 | $0.00 – $48.51 | 23,958 | 17 |
| Groton, MA | $64.84 | $2.63 – $94.28 | 23,958 | 16 |
| Blackwell, OK | $84.32 | $60.03 – $100.23 | 23,958 | 6 |
| Marion, AL | $18.01 | $0.00 – $208.61 | 23,967 | 8 |
| Purvis, MS | $64.70 | $0.00 – $133.33 | 23,982 | 12 |
| Makawao, HI | $33.25 | $0.00 – $69.14 | 23,984 | 14 |
| Gordonsville, TN | $29.45 | $26.05 – $39.47 | 23,990 | 4 |
| Guanica, PR | $3.94 | $0.00 – $23.98 | 24,000 | 12 |
| Union City, IN | $58.21 | $31.31 – $68.11 | 24,002 | 8 |
| West Milford, NJ | $32.31 | $1.78 – $79.10 | 24,013 | 6 |
| Highland, NY | $93.01 | $40.14 – $143.60 | 24,013 | 25 |
| Punta Gorda, FL | $61.26 | $0.00 – $637.58 | 24,032 | 32 |
| Roanoke, IN | $73.07 | $28.14 – $101.35 | 24,047 | 15 |
| Bristol, RI | $60.28 | $24.57 – $104.48 | 24,119 | 26 |
| Winnemucca, NV | $3.93 | $0.00 – $92.78 | 24,148 | 9 |
| Sells, AZ | $97.21 | $17.24 – $97.73 | 24,157 | 2 |
| Mitchell, IN | $61.35 | $47.17 – $90.74 | 24,157 | 6 |
| Ackerman, MS | $78.62 | $1.22 – $202.99 | 24,163 | 20 |
| Baldwyn, MS | $47.71 | $0.00 – $87.48 | 24,176 | 11 |
| Corfu, NY | $46.26 | $29.39 – $72.37 | 24,201 | 9 |
| Waldoboro, ME | $28.03 | $17.50 – $72.01 | 24,217 | 12 |
| Harvest, AL | $55.61 | $0.00 – $104.22 | 24,242 | 8 |
| Portsmouth, RI | $55.05 | $3.63 – $105.78 | 24,245 | 13 |
| Eutaw, AL | $22.90 | $0.00 – $220.50 | 24,261 | 4 |
| Tolland, CT | $55.94 | $15.81 – $71.77 | 24,264 | 17 |
| Cornettsville, KY | $35.87 | $28.60 – $44.06 | 24,280 | 4 |
| Hookerton, NC | $50.13 | $45.82 – $56.79 | 24,293 | 2 |
| Sturgis, SD | $31.26 | $13.28 – $43.64 | 24,295 | 8 |
| Kershaw, SC | $88.37 | $51.15 – $221.51 | 24,299 | 7 |
| Checotah, OK | $103.08 | $35.55 – $684.45 | 24,314 | 13 |
| Lakeville, MN | $48.16 | $7.94 – $121.26 | 24,334 | 42 |
| Chalfont, PA | $50.90 | $7.66 – $116.85 | 24,335 | 27 |
| Sterling, MA | $61.25 | $15.95 – $123.48 | 24,355 | 15 |
| Mount Prospect, IL | $54.99 | $0.00 – $282.07 | 24,357 | 31 |
| Smyrna, GA | $51.74 | $1.41 – $107.39 | 24,365 | 33 |
| Hampton, SC | $60.25 | $40.29 – $64.59 | 24,371 | 6 |
| Seaford, NY | $94.23 | $12.22 – $233.63 | 24,384 | 30 |
| Cheboygan, MI | $31.65 | $0.00 – $55.02 | 24,387 | 10 |
| Mt Washington, KY | $42.10 | $25.45 – $70.63 | 24,389 | 12 |
| Geneva, AL | $77.57 | $0.08 – $240.34 | 24,409 | 8 |
| N Andover, MA | $56.05 | $50.55 – $57.88 | 24,414 | 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.