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 |
|---|---|---|---|---|
| Cambridge, NY | $80.84 | $40.11 – $793.08 | 26,408 | 18 |
| Red Oak, IA | $28.86 | $0.02 – $48.99 | 26,410 | 14 |
| Laytonville, CA | $2.98 | $1.38 – $4.47 | 26,433 | 4 |
| Brandon, VT | $4.22 | $0.77 – $29.73 | 26,437 | 9 |
| Geneseo, IL | $23.08 | $0.00 – $64.54 | 26,445 | 11 |
| Bellows Falls, VT | $2.15 | $0.00 – $24.86 | 26,452 | 10 |
| Forney, TX | $43.92 | $0.00 – $211.46 | 26,456 | 15 |
| Vancleave, MS | $53.77 | $17.30 – $151.63 | 26,472 | 19 |
| Winamac, IN | $52.04 | $24.94 – $71.42 | 26,482 | 18 |
| Seminole, TX | $105.77 | $12.86 – $159.48 | 26,490 | 6 |
| Cuba, NM | $142.45 | $0.00 – $179.09 | 26,506 | 7 |
| Winterset, IA | $13.10 | $0.00 – $32.54 | 26,511 | 22 |
| East China, MI | $50.84 | $39.37 – $51.10 | 26,526 | 2 |
| Camdenton, MO | $64.04 | $11.58 – $103.06 | 26,527 | 18 |
| Rochelle, IL | $58.37 | $11.19 – $159.89 | 26,539 | 21 |
| Dilkon, AZ | $617.61 | $528.47 – $719.00 | 26,541 | 3 |
| Ft Myers, FL | $28.12 | $0.00 – $107.69 | 26,544 | 15 |
| Dover, TN | $54.64 | $12.26 – $141.64 | 26,563 | 10 |
| Paola, KS | $106.80 | $20.77 – $161.05 | 26,563 | 17 |
| Connelly Springs, NC | $45.16 | $5.09 – $72.20 | 26,576 | 24 |
| Etowah, TN | $35.54 | $11.85 – $63.66 | 26,588 | 15 |
| Hollis, OK | $68.43 | $64.19 – $84.02 | 26,608 | 5 |
| Blairsville, GA | $48.11 | $0.00 – $387.91 | 26,609 | 43 |
| Belding, MI | $10.46 | $10.33 – $44.29 | 26,628 | 3 |
| Spring Valley, IL | $46.22 | $12.88 – $97.80 | 26,629 | 18 |
| Gualala, CA | $36.95 | $11.81 – $45.22 | 26,639 | 2 |
| Watonga, OK | $108.88 | $80.00 – $641.91 | 26,642 | 7 |
| La Fayette, GA | $83.60 | $2.98 – $88.92 | 26,644 | 4 |
| Teecnospos, AZ | $463.12 | $64.97 – $519.00 | 26,668 | 5 |
| Keaau, HI | $133.89 | $0.00 – $349.30 | 26,693 | 13 |
| Doniphan, MO | $66.50 | $42.44 – $103.02 | 26,702 | 10 |
| Chillicothe, IL | $27.78 | $0.00 – $67.26 | 26,709 | 9 |
| North Ogden, UT | $46.18 | $34.77 – $79.14 | 26,717 | 13 |
| Abbeville, SC | $55.87 | $10.95 – $443.02 | 26,724 | 21 |
| Silvis, IL | $51.91 | $10.38 – $79.55 | 26,735 | 19 |
| Marlboro, MA | $60.83 | $33.30 – $67.21 | 26,736 | 6 |
| Peachtree Corners, GA | $60.39 | $2.70 – $71.74 | 26,757 | 10 |
| Pratt, KS | $71.48 | $3.88 – $119.48 | 26,758 | 24 |
| Kaplan, LA | $38.04 | $26.28 – $55.34 | 26,784 | 7 |
| Hillsboro, IL | $1.53 | $0.00 – $59.62 | 26,821 | 12 |
| Fort Drum, NY | $67.45 | $36.24 – $440.10 | 26,834 | 21 |
| Semmes, AL | $49.40 | $0.00 – $101.03 | 26,850 | 13 |
| Mc Farland, CA | $66.85 | $26.68 – $134.89 | 26,857 | 6 |
| Peapack, NJ | $32.02 | $32.02 – $32.02 | 26,885 | 1 |
| Jonesville, NC | $45.36 | $25.61 – $60.18 | 26,889 | 14 |
| Cleveland, OK | $165.27 | $128.81 – $198.51 | 26,893 | 8 |
| Upper Darby, PA | $30.81 | $0.00 – $68.24 | 26,917 | 21 |
| Fountain Hill, PA | $50.56 | $0.00 – $151.55 | 26,928 | 57 |
| Lancaster, NH | $107.53 | $4.11 – $541.99 | 26,930 | 20 |
| Kenansville, NC | $50.60 | $0.00 – $68.44 | 26,942 | 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.