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 |
|---|---|---|---|---|
| N Andover, MA | $56.05 | $50.55 – $57.88 | 24,414 | 6 |
| Shelburne, VT | $55.94 | $2.07 – $107.04 | 24,439 | 14 |
| Balch Springs, TX | $37.86 | $2.69 – $39.84 | 24,449 | 3 |
| Wilmette, IL | $58.89 | $12.99 – $129.44 | 24,457 | 33 |
| Blue Bell, PA | $44.76 | $0.00 – $81.15 | 24,458 | 39 |
| North Port, FL | $49.47 | $0.10 – $131.29 | 24,462 | 28 |
| Barrington, IL | $48.47 | $3.73 – $145.06 | 24,474 | 53 |
| Sumterville, FL | $47.33 | $22.15 – $70.55 | 24,476 | 13 |
| Cutler/Orosi, CA | $11.55 | $2.56 – $57.55 | 24,480 | 2 |
| Chatham, NJ | $54.64 | $9.73 – $87.58 | 24,487 | 19 |
| Columbia Falls, MT | $30.32 | $0.00 – $115.73 | 24,490 | 10 |
| Reform, AL | $35.78 | $2.13 – $93.73 | 24,502 | 10 |
| Stevensville, MT | $30.08 | $0.02 – $124.19 | 24,511 | 11 |
| Wise, VA | $44.62 | $16.94 – $51.98 | 24,532 | 6 |
| Warrenton, MO | $58.57 | $8.93 – $107.33 | 24,534 | 23 |
| Mc Connellsburg, PA | $17.62 | $1.33 – $63.62 | 24,535 | 14 |
| St. Paul, MN | $73.94 | $26.22 – $160.63 | 24,547 | 42 |
| New Canaan, CT | $58.02 | $0.00 – $86.13 | 24,565 | 25 |
| Sarepta, LA | $0.00 | $0.00 – $0.00 | 24,587 | 4 |
| Sterlington, LA | $64.63 | $0.00 – $77.12 | 24,616 | 7 |
| Laplace, LA | $16.65 | $16.65 – $16.65 | 24,626 | 1 |
| Benton, LA | $9.49 | $0.00 – $41.63 | 24,633 | 6 |
| Spencer, IN | $66.61 | $43.60 – $120.39 | 24,643 | 13 |
| Columbus, KS | $140.76 | $10.31 – $170.83 | 24,671 | 13 |
| Diberville, MS | $58.19 | $19.21 – $89.78 | 24,681 | 14 |
| Sealy, TX | $36.96 | $0.00 – $37.44 | 24,719 | 3 |
| Glenville, WV | $10.23 | $0.00 – $75.88 | 24,722 | 10 |
| Logansport, LA | $2.36 | $0.00 – $11.75 | 24,723 | 3 |
| Medina, TN | $34.34 | $6.31 – $38.78 | 24,730 | 8 |
| Joint Base Lewis Mcchord, WA | $60.09 | $17.39 – $268.49 | 24,733 | 24 |
| Bethany, MO | $70.55 | $16.65 – $327.86 | 24,735 | 8 |
| Edmore, MI | $69.25 | $26.96 – $69.62 | 24,738 | 3 |
| Burlington, KS | $118.60 | $30.46 – $127.43 | 24,755 | 7 |
| Elk River, MN | $66.03 | $34.58 – $119.03 | 24,756 | 51 |
| Keosauqua, IA | $13.30 | $0.00 – $32.46 | 24,766 | 10 |
| Colchester, CT | $52.84 | $9.47 – $77.19 | 24,770 | 20 |
| Purcell, OK | $333.97 | $22.66 – $682.45 | 24,777 | 22 |
| Oscoda, MI | $17.27 | $0.68 – $24.18 | 24,783 | 4 |
| Frostproof, FL | $40.69 | $18.58 – $53.95 | 24,786 | 6 |
| Webb City, MO | $59.20 | $16.94 – $84.15 | 24,794 | 18 |
| Wyckoff, NJ | $56.40 | $0.00 – $71.98 | 24,799 | 11 |
| Inver Grove Heights, MN | $63.93 | $18.85 – $145.20 | 24,800 | 37 |
| Pemberton, NJ | $27.12 | $0.00 – $106.02 | 24,803 | 7 |
| Pulaski, VA | $44.97 | $1.44 – $94.29 | 24,803 | 19 |
| Walton, KY | $45.09 | $35.98 – $61.77 | 24,803 | 12 |
| Rosiclare, IL | $1.08 | $0.94 – $35.12 | 24,828 | 2 |
| Hobart, OK | $73.87 | $23.55 – $271.84 | 24,840 | 9 |
| Charlevoix, MI | $46.92 | $18.71 – $48.18 | 24,880 | 5 |
| Myrtle Creek, OR | $51.14 | $10.80 – $102.73 | 24,899 | 12 |
| Loranger, LA | $2.67 | $0.00 – $38.45 | 24,919 | 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.