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 |
|---|---|---|---|---|
| Iowa Falls, IA | $39.82 | $12.06 – $48.19 | 39,840 | 13 |
| Troy, MO | $54.07 | $3.50 – $152.61 | 39,849 | 43 |
| Penfield, NY | $73.17 | $46.66 – $108.56 | 39,863 | 58 |
| Glen Ellyn, IL | $54.23 | $0.00 – $104.01 | 39,866 | 70 |
| Broken Bow, OK | $74.05 | $1.17 – $91.45 | 39,873 | 11 |
| Sumrall, MS | $74.32 | $23.28 – $124.84 | 39,898 | 19 |
| Greensboro, GA | $72.63 | $14.66 – $122.53 | 39,914 | 16 |
| Walnut Hills, OH | $62.72 | $0.33 – $97.69 | 39,940 | 12 |
| Snellville, GA | $44.34 | $0.00 – $121.09 | 39,969 | 39 |
| Sweet Home, OR | $73.67 | $24.26 – $112.16 | 39,988 | 15 |
| Greenville, ME | $5.85 | $4.64 – $11.62 | 40,019 | 2 |
| Wolfeboro, NH | $28.03 | $5.68 – $208.66 | 40,020 | 27 |
| Chapin, SC | $73.21 | $36.46 – $87.84 | 40,061 | 19 |
| Asbury Park, NJ | $37.20 | $0.03 – $70.92 | 40,076 | 20 |
| Alexandria, KY | $36.80 | $15.66 – $95.43 | 40,138 | 15 |
| Mayfield Hts, OH | $38.38 | $0.00 – $91.20 | 40,145 | 52 |
| Lakewood Ranch, FL | $50.86 | $0.00 – $125.70 | 40,147 | 30 |
| Hawthorne, NJ | $66.00 | $0.00 – $79.55 | 40,149 | 20 |
| Phoenixville, PA | $42.60 | $0.00 – $100.04 | 40,154 | 62 |
| Acton, MA | $78.38 | $1.97 – $108.50 | 40,171 | 43 |
| Montgomery, WV | $20.08 | $0.70 – $57.73 | 40,176 | 17 |
| Jonesville, VA | $40.03 | $10.46 – $74.03 | 40,178 | 9 |
| Sunbury, PA | $40.10 | $2.19 – $155.60 | 40,237 | 13 |
| Innis, LA | $21.41 | $0.00 – $63.40 | 40,270 | 6 |
| Brandywine, MD | $77.48 | $0.68 – $157.73 | 40,283 | 35 |
| Colfax, WA | $29.47 | $9.95 – $77.24 | 40,323 | 21 |
| Williston, ND | $73.00 | $0.00 – $352.18 | 40,339 | 53 |
| Rockport, AR | $39.30 | $26.00 – $41.84 | 40,358 | 4 |
| Sugarloaf, PA | $49.22 | $30.19 – $85.12 | 40,408 | 14 |
| Halethorpe, MD | $97.47 | $16.70 – $209.06 | 40,452 | 37 |
| Hardin, MT | $21.39 | $0.00 – $105.12 | 40,488 | 11 |
| Hudson, NC | $58.34 | $33.48 – $85.16 | 40,503 | 11 |
| Lyndhurst, OH | $36.11 | $10.43 – $81.02 | 40,535 | 29 |
| Round Mountain, CA | $1.80 | $0.64 – $2.43 | 40,560 | 6 |
| Pepper Pike, OH | $57.33 | $19.85 – $116.57 | 40,582 | 7 |
| Moss Point, MS | $76.28 | $0.00 – $312.61 | 40,592 | 30 |
| Highland, MI | $59.81 | $45.12 – $76.20 | 40,604 | 8 |
| Evarts, KY | $25.71 | $14.91 – $31.89 | 40,610 | 7 |
| Mamaroneck, NY | $75.11 | $31.52 – $148.01 | 40,642 | 29 |
| Shawnee, KS | $41.39 | $2.19 – $282.32 | 40,647 | 58 |
| Tonawanda, NY | $49.49 | $8.12 – $156.62 | 40,649 | 41 |
| Chiefland, FL | $51.08 | $20.78 – $671.61 | 40,705 | 14 |
| Sturtevant, WI | $47.09 | $0.02 – $55.54 | 40,712 | 6 |
| Craig, CO | $204.65 | $0.00 – $372.36 | 40,725 | 34 |
| Colchester, VT | $37.10 | $0.00 – $526.22 | 40,752 | 48 |
| Eagar, AZ | $50.77 | $0.00 – $57.84 | 40,761 | 8 |
| Navarre, FL | $44.52 | $9.81 – $67.67 | 40,784 | 27 |
| Holden, MA | $68.87 | $26.83 – $106.08 | 40,797 | 35 |
| Newton, NC | $61.47 | $6.59 – $333.30 | 40,819 | 26 |
| Frackville, PA | $28.87 | $0.00 – $64.32 | 40,840 | 14 |
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.