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 |
|---|---|---|---|---|
| Coventry, CT | $45.13 | $8.77 – $70.00 | 34,364 | 17 |
| Calistoga, CA | $7.46 | $2.62 – $45.30 | 34,375 | 6 |
| Bolivia, NC | $55.25 | $1.69 – $96.84 | 34,376 | 34 |
| Punxsutawney, PA | $24.95 | $0.00 – $72.84 | 34,398 | 36 |
| Danville, CA | $44.64 | $0.00 – $215.46 | 34,427 | 22 |
| Chestnut Hill, MA | $56.10 | $5.09 – $246.56 | 34,433 | 78 |
| Phelps, KY | $28.18 | $17.68 – $33.41 | 34,460 | 6 |
| Liberty, MS | $39.45 | $17.08 – $109.01 | 34,467 | 11 |
| Chatsworth, GA | $44.93 | $23.06 – $85.53 | 34,482 | 25 |
| South Amboy, NJ | $61.98 | $7.38 – $121.89 | 34,497 | 9 |
| Dayton, WA | $50.73 | $22.04 – $74.29 | 34,534 | 18 |
| North Liberty, IA | $44.05 | $12.91 – $84.99 | 34,568 | 44 |
| Mohave Valley, AZ | $36.00 | $0.02 – $46.80 | 34,585 | 6 |
| Mauldin, SC | $50.95 | $32.90 – $73.93 | 34,609 | 17 |
| Fabens, TX | $43.48 | $0.00 – $49.05 | 34,623 | 5 |
| Bridgeport, MI | $16.39 | $14.83 – $59.56 | 34,633 | 2 |
| Madison, FL | $31.00 | $0.00 – $87.54 | 34,691 | 13 |
| Atlanta, TX | $49.54 | $16.79 – $63.86 | 34,700 | 12 |
| Port Washington, WI | $32.41 | $9.50 – $50.93 | 34,718 | 30 |
| Cross Lanes, WV | $39.23 | $0.08 – $69.22 | 34,719 | 15 |
| Wylie, TX | $26.38 | $4.40 – $59.57 | 34,720 | 17 |
| Albert Lea, MN | $51.44 | $8.45 – $180.23 | 34,721 | 61 |
| Newtown, PA | $46.32 | $0.00 – $146.11 | 34,733 | 31 |
| Laveen, AZ | $67.84 | $0.00 – $122.98 | 34,740 | 23 |
| Hampstead, MD | $100.31 | $17.28 – $165.11 | 34,763 | 26 |
| Grantsville, WV | $5.17 | $0.00 – $10.48 | 34,776 | 13 |
| Pelham, AL | $70.26 | $0.00 – $221.96 | 34,788 | 24 |
| Merchantville, NJ | $83.23 | $23.88 – $102.20 | 34,817 | 7 |
| Williston, FL | $32.30 | $22.33 – $37.41 | 34,824 | 12 |
| Dunkirk, MD | $78.98 | $0.00 – $162.67 | 34,828 | 13 |
| Hamilton, NY | $62.72 | $5.80 – $100.17 | 34,828 | 27 |
| Bethel, CT | $52.93 | $0.00 – $91.91 | 34,860 | 20 |
| Millersburg, OH | $37.92 | $22.10 – $45.77 | 34,879 | 16 |
| Hummelstown, PA | $52.19 | $2.43 – $121.89 | 34,890 | 21 |
| South El Monte, CA | $18.40 | $0.00 – $43.05 | 34,909 | 7 |
| Fallsburg, NY | $62.52 | $62.22 – $78.68 | 34,911 | 2 |
| Eaton Rapids, MI | $21.96 | $16.38 – $48.30 | 34,922 | 5 |
| Whitestone, NY | $79.46 | $25.65 – $108.49 | 34,930 | 12 |
| Owatonna, MN | $87.57 | $15.63 – $249.91 | 34,940 | 69 |
| East Norriton, PA | $36.88 | $0.02 – $143.71 | 34,956 | 53 |
| Bernice, LA | $3.98 | $0.00 – $43.66 | 34,958 | 4 |
| Thomasville, AL | $20.39 | $0.00 – $71.94 | 34,968 | 14 |
| Douglas, GA | $48.63 | $0.00 – $110.43 | 34,970 | 15 |
| Mission, SD | $163.34 | $76.28 – $165.42 | 34,982 | 2 |
| Ceiba, PR | $0.61 | $0.00 – $14.00 | 34,992 | 7 |
| Livingston, AL | $15.96 | $0.10 – $197.15 | 35,014 | 3 |
| Monument, CO | $128.27 | $4.24 – $344.76 | 35,016 | 31 |
| Monticello, IL | $12.74 | $0.00 – $66.89 | 35,016 | 17 |
| La Salle, IL | $15.95 | $0.00 – $109.06 | 35,067 | 6 |
| Keenesburg, CO | $64.49 | $63.15 – $64.67 | 35,082 | 2 |
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.