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 |
|---|---|---|---|---|
| Capitol Heights, MD | $103.32 | $73.19 – $182.54 | 30,109 | 8 |
| Siler City, NC | $59.26 | $18.54 – $80.99 | 30,133 | 24 |
| Elkton, VA | $55.54 | $35.64 – $68.26 | 30,181 | 15 |
| Fredericksburg, TX | $46.40 | $17.61 – $638.33 | 30,185 | 29 |
| Manchester Center, VT | $67.26 | $0.01 – $118.63 | 30,189 | 18 |
| Los Alamos, NM | $101.29 | $0.00 – $588.86 | 30,190 | 43 |
| Red Oak, TX | $40.61 | $10.32 – $44.35 | 30,200 | 7 |
| Hebron, KY | $37.94 | $16.19 – $50.71 | 30,201 | 20 |
| Westfield, NY | $71.86 | $0.00 – $100.55 | 30,203 | 26 |
| King George, VA | $66.55 | $10.83 – $97.68 | 30,204 | 20 |
| Welsh, LA | $37.02 | $30.72 – $46.86 | 30,224 | 3 |
| Cobleskill, NY | $78.32 | $22.66 – $105.58 | 30,230 | 20 |
| Cornelius, OR | $27.53 | $7.22 – $63.03 | 30,247 | 14 |
| Bonners Ferry, ID | $7.38 | $0.02 – $59.24 | 30,271 | 19 |
| Gold Beach, OR | $63.73 | $0.00 – $90.95 | 30,291 | 16 |
| Raymond, NH | $12.83 | $0.00 – $125.84 | 30,305 | 27 |
| Lyons, NY | $119.77 | $52.63 – $131.85 | 30,314 | 8 |
| Leavenworth, WA | $27.88 | $3.48 – $64.06 | 30,329 | 15 |
| Wilmer, AL | $3.36 | $0.01 – $5.86 | 30,337 | 3 |
| Trophy Club, TX | $50.98 | $40.99 – $62.17 | 30,339 | 5 |
| Mesquite, NV | $53.16 | $1.13 – $366.00 | 30,368 | 30 |
| Frederiksted, VI | $152.11 | $92.24 – $197.72 | 30,375 | 10 |
| Lake City, IA | $5.56 | $0.00 – $88.58 | 30,378 | 10 |
| Glen Carbon, IL | $54.99 | $7.00 – $81.09 | 30,382 | 23 |
| Medford, WI | $46.68 | $9.27 – $155.48 | 30,383 | 32 |
| Glenwood, IA | $40.78 | $0.00 – $80.51 | 30,399 | 9 |
| Huntington Woods, MI | $74.49 | $10.57 – $75.68 | 30,411 | 3 |
| West Harrison, IN | $67.69 | $39.82 – $86.17 | 30,419 | 4 |
| Moorhead, MN | $94.86 | $17.10 – $536.98 | 30,434 | 38 |
| Perryville, MD | $93.95 | $21.52 – $99.02 | 30,445 | 8 |
| Deptford, NJ | $45.68 | $10.81 – $219.10 | 30,447 | 12 |
| Fredericktown, OH | $43.80 | $12.40 – $52.65 | 30,457 | 10 |
| Warwick, NY | $99.29 | $34.02 – $122.29 | 30,462 | 19 |
| Spring Lake, NC | $51.54 | $2.63 – $63.25 | 30,465 | 9 |
| Adamsville, TN | $31.79 | $1.75 – $45.93 | 30,478 | 13 |
| Oakdale, MN | $85.55 | $20.82 – $163.10 | 30,482 | 29 |
| Carson City, MI | $23.88 | $16.21 – $49.75 | 30,501 | 8 |
| Parsons, TN | $35.33 | $14.24 – $44.38 | 30,503 | 9 |
| Pembroke, MA | $47.30 | $1.85 – $102.14 | 30,505 | 28 |
| Versailles, MO | $75.68 | $17.65 – $104.28 | 30,507 | 10 |
| White River Junction, VT | $64.09 | $0.00 – $81.09 | 30,513 | 27 |
| Sale Creek, TN | $39.50 | $33.00 – $50.43 | 30,538 | 8 |
| Plymouth Meeting, PA | $53.35 | $0.00 – $125.39 | 30,559 | 61 |
| Canton, CT | $43.93 | $0.00 – $80.02 | 30,575 | 12 |
| Saddle Brook, NJ | $44.21 | $26.05 – $123.09 | 30,605 | 7 |
| Spirit Lake, IA | $32.93 | $19.55 – $41.95 | 30,616 | 21 |
| Colts Neck, NJ | $58.61 | $10.04 – $104.45 | 30,681 | 13 |
| La Vista, NE | $57.19 | $11.48 – $114.78 | 30,684 | 27 |
| Jefferson, IA | $8.76 | $1.89 – $53.82 | 30,711 | 11 |
| Malabar, FL | $32.37 | $12.97 – $64.43 | 30,714 | 13 |
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.