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 |
|---|---|---|---|---|
| Dunlap, TN | $40.36 | $2.58 – $82.32 | 24,923 | 16 |
| Hartford City, IN | $56.37 | $28.25 – $66.90 | 24,923 | 11 |
| Glencoe, MN | $41.58 | $15.60 – $90.58 | 24,924 | 27 |
| Gales Ferry, CT | $81.46 | $37.96 – $99.52 | 24,928 | 12 |
| Sunset Beach, NC | $39.02 | $2.12 – $58.52 | 24,934 | 4 |
| Mc Kees Rocks, PA | $39.06 | $0.00 – $53.27 | 24,937 | 22 |
| Bandon, OR | $20.99 | $0.03 – $121.06 | 24,939 | 14 |
| Blacklick, OH | $52.18 | $37.97 – $88.18 | 24,940 | 10 |
| Kill Devil Hills, NC | $59.88 | $31.80 – $68.60 | 24,951 | 9 |
| Englishtown, NJ | $40.87 | $15.13 – $113.54 | 24,961 | 9 |
| Belle, WV | $5.58 | $0.00 – $17.42 | 24,961 | 2 |
| Sewanee, TN | $36.45 | $0.00 – $90.80 | 24,961 | 6 |
| Cresco, IA | $7.37 | $0.31 – $45.36 | 24,964 | 15 |
| Mantachie, MS | $46.04 | $17.04 – $72.13 | 24,977 | 16 |
| Saugus, MA | $53.46 | $5.90 – $109.06 | 24,977 | 18 |
| Marion, AR | $28.10 | $0.00 – $51.99 | 24,985 | 25 |
| Fort Sam Houston, TX | $65.16 | $0.00 – $434.20 | 25,011 | 44 |
| Prairie Village, KS | $44.93 | $17.82 – $105.70 | 25,029 | 25 |
| Paoli, PA | $53.20 | $0.86 – $158.15 | 25,033 | 46 |
| Rocky Ford, CO | $135.25 | $70.08 – $176.25 | 25,048 | 5 |
| Fulton, MS | $45.99 | $0.00 – $63.08 | 25,060 | 16 |
| West Amherst, NY | $48.34 | $13.55 – $75.50 | 25,075 | 25 |
| Mt Sterling, IL | $10.72 | $0.00 – $59.29 | 25,079 | 6 |
| Fairmont, MN | $53.22 | $8.54 – $135.44 | 25,090 | 41 |
| Hampton, IA | $6.08 | $0.00 – $54.09 | 25,096 | 9 |
| Bethel, ME | $3.64 | $0.48 – $51.59 | 25,102 | 4 |
| Grand Haven, MI | $61.27 | $2.92 – $801.74 | 25,105 | 18 |
| Andover, KS | $42.40 | $0.00 – $158.89 | 25,134 | 38 |
| Richlands, NC | $51.00 | $36.35 – $60.56 | 25,146 | 8 |
| Rogers City, MI | $18.96 | $18.65 – $44.22 | 25,152 | 2 |
| Palos Hills, IL | $59.16 | $11.25 – $96.26 | 25,157 | 19 |
| Purcellville, VA | $63.56 | $0.09 – $95.20 | 25,165 | 22 |
| Los Altos, CA | $41.25 | $0.00 – $457.23 | 25,197 | 23 |
| Anoka, MN | $60.20 | $27.03 – $109.74 | 25,215 | 40 |
| Salem, AR | $35.80 | $0.00 – $55.76 | 25,228 | 11 |
| Wolcott, NY | $70.68 | $55.42 – $91.85 | 25,228 | 7 |
| Society Hill, SC | $166.22 | $47.80 – $311.69 | 25,266 | 7 |
| Crownsville, MD | $121.07 | $2.99 – $181.53 | 25,267 | 9 |
| Princeton, MN | $44.50 | $13.33 – $205.95 | 25,270 | 27 |
| Owego, NY | $72.46 | $2.43 – $128.46 | 25,272 | 19 |
| Tuolumne, CA | $56.18 | $0.00 – $660.30 | 25,288 | 11 |
| Scotts Valley, CA | $16.51 | $1.79 – $87.61 | 25,302 | 14 |
| Oakland, NJ | $71.59 | $33.29 – $88.29 | 25,306 | 10 |
| Carrollton, IL | $3.85 | $0.01 – $42.81 | 25,311 | 7 |
| Montezuma, GA | $99.94 | $64.71 – $115.01 | 25,329 | 3 |
| West Pawlet, VT | $33.39 | $0.41 – $79.09 | 25,346 | 10 |
| Ridgefield, WA | $96.77 | $40.72 – $314.40 | 25,371 | 9 |
| Birmingham, MI | $63.91 | $8.22 – $74.01 | 25,377 | 9 |
| Cave Creek, AZ | $60.27 | $0.00 – $92.50 | 25,382 | 14 |
| Lewis Center, OH | $55.56 | $11.73 – $81.86 | 25,431 | 23 |
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.