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 |
|---|---|---|---|---|
| Hickory Hills, IL | $68.88 | $3.97 – $94.48 | 27,625 | 7 |
| Eastville, VA | $56.47 | $44.20 – $90.87 | 27,643 | 13 |
| Shiloh, IL | $57.38 | $8.84 – $107.10 | 27,659 | 49 |
| Guadalupe, CA | $8.16 | $0.14 – $85.09 | 27,708 | 5 |
| Liberty Lake, WA | $60.98 | $6.39 – $87.90 | 27,723 | 20 |
| Succasunna, NJ | $47.34 | $25.19 – $101.25 | 27,726 | 11 |
| Landis, NC | $69.38 | $69.38 – $69.38 | 27,781 | 1 |
| Blanchard, OK | $90.57 | $42.80 – $654.00 | 27,816 | 15 |
| Huron, OH | $35.48 | $15.58 – $53.97 | 27,827 | 9 |
| Fords, NJ | $41.32 | $25.85 – $94.72 | 27,832 | 11 |
| Butler, AL | $25.36 | $0.00 – $226.15 | 27,853 | 7 |
| Upland, PA | $38.33 | $5.16 – $108.98 | 27,854 | 31 |
| Galena, IL | $22.36 | $0.00 – $85.06 | 27,865 | 16 |
| Perryville, MO | $63.47 | $15.95 – $121.59 | 27,869 | 21 |
| Streamwood, IL | $31.32 | $0.12 – $140.28 | 27,872 | 10 |
| North Stonington, CT | $67.45 | $0.00 – $88.59 | 27,891 | 9 |
| Andover, OH | $28.53 | $0.03 – $60.15 | 27,896 | 5 |
| North Bellmore, NY | $57.76 | $29.38 – $62.99 | 27,923 | 12 |
| Demorest, GA | $62.63 | $0.00 – $110.40 | 27,924 | 15 |
| Saint John, IN | $62.15 | $23.18 – $89.09 | 27,968 | 24 |
| New Castle, KY | $40.32 | $31.50 – $42.01 | 27,980 | 3 |
| Vernon Hills, IL | $49.95 | $9.33 – $94.88 | 28,010 | 46 |
| Van Buren, MO | $79.94 | $12.00 – $85.36 | 28,059 | 4 |
| Bristow, OK | $76.29 | $22.28 – $110.79 | 28,071 | 11 |
| Owenton, KY | $30.23 | $17.20 – $33.12 | 28,073 | 8 |
| Guntown, MS | $52.40 | $16.43 – $58.82 | 28,086 | 6 |
| Chesapeake, OH | $22.42 | $3.72 – $54.16 | 28,089 | 5 |
| Ware, MA | $60.93 | $9.46 – $111.82 | 28,089 | 17 |
| Park City, UT | $70.30 | $2.39 – $676.87 | 28,105 | 46 |
| Clear Lake, IA | $27.43 | $0.00 – $33.61 | 28,108 | 21 |
| Mc Henry, MD | $63.23 | $26.31 – $96.99 | 28,110 | 4 |
| Clarkrange, TN | $23.30 | $23.30 – $23.30 | 28,126 | 1 |
| Northport, NY | $76.76 | $0.92 – $182.78 | 28,127 | 26 |
| Belington, WV | $7.64 | $0.00 – $12.45 | 28,144 | 11 |
| Lackey, KY | $35.10 | $32.86 – $44.00 | 28,149 | 4 |
| Yorktown, VA | $55.32 | $4.51 – $75.84 | 28,156 | 20 |
| Cuba, NY | $83.33 | $43.86 – $151.41 | 28,170 | 12 |
| East Moriches, NY | $56.73 | $4.03 – $98.12 | 28,190 | 11 |
| Ewing, VA | $48.71 | $39.88 – $50.25 | 28,192 | 2 |
| Trafalgar, IN | $57.55 | $39.44 – $84.25 | 28,202 | 10 |
| Bellingham, MA | $83.98 | $44.66 – $102.18 | 28,203 | 11 |
| Nixa, MO | $68.04 | $15.04 – $131.56 | 28,205 | 24 |
| Baldwinsville, NY | $44.76 | $12.05 – $103.84 | 28,221 | 18 |
| Mountain Lakes, NJ | $51.59 | $7.59 – $97.95 | 28,226 | 17 |
| Roanoke, AL | $39.01 | $0.00 – $225.30 | 28,233 | 13 |
| Siletz, OR | $95.23 | $17.78 – $474.39 | 28,234 | 10 |
| Ridley Park, PA | $47.23 | $1.10 – $104.60 | 28,243 | 21 |
| Jefferson, OH | $44.33 | $30.66 – $52.78 | 28,247 | 6 |
| Holdrege, NE | $69.46 | $10.67 – $202.10 | 28,267 | 22 |
| Fairview Heights, IL | $58.06 | $27.96 – $97.54 | 28,329 | 15 |
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.