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 |
|---|---|---|---|---|
| Valley City, ND | $78.68 | $10.27 – $90.91 | 25,432 | 18 |
| Florence, AZ | $95.87 | $0.00 – $474.88 | 25,432 | 11 |
| Springdale, OH | $57.24 | $33.94 – $104.84 | 25,437 | 4 |
| Roxbury Crossing, MA | $27.35 | $1.68 – $71.60 | 25,477 | 7 |
| Moon Township, PA | $59.72 | $10.88 – $85.18 | 25,479 | 20 |
| Starke, FL | $27.75 | $0.18 – $36.19 | 25,484 | 18 |
| North Chili, NY | $52.42 | $33.62 – $103.20 | 25,487 | 14 |
| Clinton, KY | $27.18 | $12.14 – $62.64 | 25,497 | 5 |
| Hanceville, AL | $12.32 | $2.29 – $62.99 | 25,498 | 8 |
| Berlin, WI | $44.34 | $17.48 – $157.18 | 25,500 | 24 |
| Maunabo, PR | $0.56 | $0.00 – $4.53 | 25,520 | 6 |
| Spotswood, NJ | $37.21 | $0.00 – $106.70 | 25,538 | 7 |
| Madawaska, ME | $12.95 | $7.07 – $31.67 | 25,546 | 4 |
| West Richland, WA | $73.48 | $30.53 – $375.00 | 25,549 | 16 |
| Mc Dowell, KY | $23.85 | $0.26 – $27.95 | 25,565 | 9 |
| Nappanee, IN | $56.64 | $36.11 – $73.54 | 25,568 | 18 |
| Saratoga, CA | $55.59 | $7.34 – $94.18 | 25,568 | 5 |
| Cherryville, NC | $59.11 | $23.83 – $74.47 | 25,577 | 11 |
| Bellaire, MI | $16.46 | $16.46 – $16.46 | 25,580 | 1 |
| Wewoka, OK | $115.34 | $0.00 – $136.62 | 25,584 | 9 |
| Cecilia, KY | $15.67 | $15.57 – $23.27 | 25,586 | 2 |
| Sunny Isles Beach, FL | $6.09 | $1.18 – $105.63 | 25,598 | 10 |
| Mundelein, IL | $40.20 | $10.44 – $78.59 | 25,609 | 13 |
| Low Moor, VA | $38.92 | $0.00 – $82.18 | 25,619 | 22 |
| Berkeley Heights, NJ | $55.48 | $0.00 – $167.89 | 25,632 | 52 |
| Storrs, CT | $49.85 | $29.85 – $118.95 | 25,639 | 23 |
| Adel, IA | $41.07 | $25.40 – $72.35 | 25,668 | 6 |
| Raritan, NJ | $77.92 | $0.00 – $125.63 | 25,668 | 20 |
| Nassawadox, VA | $40.22 | $11.37 – $151.38 | 25,671 | 20 |
| Cohoes, NY | $65.38 | $0.00 – $221.85 | 25,689 | 16 |
| Blue Ridge, GA | $40.47 | $16.27 – $146.15 | 25,698 | 25 |
| Fairdale, KY | $40.14 | $30.92 – $53.27 | 25,702 | 8 |
| Pollock, LA | $23.57 | $0.19 – $40.68 | 25,724 | 2 |
| Pearl River, LA | $35.88 | $28.82 – $51.99 | 25,770 | 4 |
| Columbus, WI | $142.29 | $12.89 – $192.62 | 25,794 | 18 |
| Tarpon Springs, FL | $50.48 | $0.09 – $93.36 | 25,799 | 20 |
| Newaygo, MI | $13.56 | $5.59 – $76.58 | 25,811 | 3 |
| Midlothian, TX | $51.58 | $22.30 – $352.84 | 25,845 | 15 |
| Bennetsville, SC | $177.11 | $76.23 – $186.27 | 25,857 | 2 |
| Union, MS | $44.64 | $5.87 – $139.61 | 25,863 | 10 |
| Boone, IA | $37.56 | $21.46 – $51.13 | 25,864 | 15 |
| Boerne, TX | $49.51 | $0.00 – $97.95 | 25,880 | 35 |
| Minooka, IL | $52.18 | $20.56 – $301.81 | 25,893 | 4 |
| Sturbridge, MA | $37.19 | $4.39 – $86.16 | 25,895 | 19 |
| Melvindale, MI | $59.27 | $59.24 – $61.61 | 25,901 | 2 |
| Pisgah, AL | $3.89 | $1.52 – $5.94 | 25,909 | 2 |
| Kew Gardens Hills, NY | $70.10 | $59.83 – $78.50 | 25,909 | 4 |
| Creve Coeur, MO | $52.26 | $10.47 – $105.50 | 25,914 | 42 |
| Gwinn, MI | $31.25 | $30.53 – $92.44 | 25,928 | 3 |
| Westbrook, CT | $34.43 | $0.01 – $81.76 | 25,962 | 20 |
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.