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 |
|---|---|---|---|---|
| Laurens, SC | $59.62 | $14.24 – $150.91 | 32,957 | 22 |
| Vestavia, AL | $68.53 | $0.96 – $143.34 | 32,957 | 29 |
| Frankenmuth, MI | $71.23 | $42.91 – $93.98 | 32,962 | 6 |
| Hercules, CA | $32.80 | $0.24 – $58.43 | 32,970 | 4 |
| Wahiawa, HI | $86.71 | $0.00 – $257.19 | 32,990 | 18 |
| Weatherford, TX | $45.74 | $7.43 – $596.07 | 33,011 | 37 |
| Fort Hood, TX | $46.90 | $0.00 – $654.21 | 33,022 | 29 |
| Altoona, IA | $37.02 | $0.00 – $76.64 | 33,066 | 21 |
| Nyc, NY | $60.09 | $6.19 – $132.17 | 33,093 | 7 |
| Elkridge, MD | $87.94 | $16.05 – $191.39 | 33,103 | 34 |
| Crandon, WI | $32.97 | $0.00 – $66.88 | 33,116 | 18 |
| Morton, MS | $68.64 | $25.91 – $99.20 | 33,126 | 12 |
| Cicero, NY | $72.97 | $1.23 – $115.13 | 33,143 | 25 |
| Holdenville, OK | $87.67 | $0.00 – $117.69 | 33,148 | 9 |
| Fulton, MD | $66.50 | $6.48 – $181.71 | 33,151 | 23 |
| Anadarko, OK | $310.88 | $2.67 – $652.78 | 33,154 | 15 |
| Markham, IL | $49.84 | $45.89 – $49.84 | 33,173 | 2 |
| Fairview, TN | $41.78 | $31.59 – $51.55 | 33,193 | 12 |
| Hightstown, NJ | $8.20 | $8.12 – $59.30 | 33,200 | 2 |
| Loxahatchee Groves, FL | $75.45 | $36.82 – $94.76 | 33,217 | 7 |
| Jamestown, KY | $34.16 | $21.81 – $36.75 | 33,230 | 8 |
| El Dorado Springs, MO | $27.01 | $4.33 – $109.45 | 33,245 | 16 |
| Channahon, IL | $48.44 | $0.00 – $68.47 | 33,260 | 16 |
| Mebane, NC | $63.71 | $30.72 – $124.89 | 33,281 | 27 |
| Calais, ME | $11.64 | $0.00 – $108.65 | 33,291 | 12 |
| Mason, WV | $41.85 | $14.20 – $61.85 | 33,309 | 7 |
| Towanda, PA | $42.81 | $0.00 – $87.19 | 33,357 | 13 |
| Northern Cambria, PA | $42.02 | $36.69 – $42.54 | 33,357 | 3 |
| Forestdale, MA | $52.98 | $35.86 – $72.72 | 33,360 | 9 |
| Redwood Falls, MN | $146.66 | $47.04 – $210.16 | 33,392 | 23 |
| Centreville, MD | $86.14 | $18.59 – $122.38 | 33,401 | 19 |
| Havana, IL | $3.64 | $0.24 – $43.88 | 33,410 | 3 |
| Soquel, CA | $29.91 | $0.00 – $99.27 | 33,411 | 22 |
| Sicily Island, LA | $0.99 | $0.00 – $22.53 | 33,413 | 6 |
| Gatesville, TX | $43.96 | $0.00 – $127.58 | 33,441 | 28 |
| Sedro Woolley, WA | $52.30 | $0.00 – $72.90 | 33,443 | 19 |
| Wofford Heights, CA | $11.91 | $7.34 – $22.58 | 33,446 | 3 |
| Plantsville, CT | $46.98 | $3.79 – $58.57 | 33,470 | 15 |
| Carlisle, KY | $31.14 | $21.02 – $88.95 | 33,480 | 10 |
| Berkeley Springs, WV | $27.70 | $0.10 – $62.92 | 33,486 | 17 |
| Erwin, NC | $44.20 | $18.05 – $64.48 | 33,492 | 17 |
| Manistique, MI | $36.25 | $35.35 – $36.43 | 33,506 | 2 |
| Riverton, WY | $34.35 | $0.00 – $85.63 | 33,511 | 27 |
| Westfield, NJ | $55.85 | $1.82 – $170.07 | 33,531 | 42 |
| Rosebud, SD | $395.90 | $35.67 – $640.00 | 33,537 | 4 |
| Mangonia Park, FL | $88.51 | $1.28 – $126.27 | 33,554 | 14 |
| Wharton, TX | $27.47 | $0.00 – $54.12 | 33,562 | 20 |
| Scarbro, WV | $16.72 | $15.74 – $32.35 | 33,585 | 3 |
| Central Falls, RI | $51.27 | $4.41 – $90.13 | 33,594 | 9 |
| Science Hill, KY | $32.07 | $18.60 – $39.41 | 33,608 | 5 |
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.