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 |
|---|---|---|---|---|
| Mendota, IL | $15.93 | $0.00 – $52.05 | 41,812 | 11 |
| Wolf Point, MT | $0.35 | $0.00 – $56.10 | 41,823 | 3 |
| Oakley, CA | $11.11 | $1.16 – $49.29 | 41,834 | 8 |
| Tipp City, OH | $55.18 | $2.48 – $86.14 | 41,836 | 20 |
| Elizabethtown, NY | $137.05 | $39.56 – $209.28 | 41,897 | 8 |
| Alamo, TN | $42.61 | $15.65 – $48.14 | 41,906 | 9 |
| Pomona, NJ | $12.42 | $3.95 – $151.63 | 41,937 | 13 |
| Brookings, SD | $63.40 | $23.07 – $154.50 | 41,979 | 7 |
| Chariton, IA | $6.83 | $0.00 – $47.71 | 41,980 | 17 |
| Beacon, NY | $97.28 | $0.74 – $178.67 | 41,985 | 16 |
| Liberty, MO | $62.93 | $0.28 – $120.31 | 41,985 | 66 |
| South Elgin, IL | $45.60 | $0.38 – $105.84 | 42,025 | 27 |
| Millinocket, ME | $29.01 | $3.11 – $601.19 | 42,031 | 10 |
| Chester, SC | $64.97 | $17.21 – $231.03 | 42,044 | 12 |
| Brecksville, OH | $54.63 | $20.35 – $97.15 | 42,052 | 26 |
| Silverton, OR | $67.57 | $0.00 – $136.58 | 42,054 | 49 |
| Clarinda, IA | $38.80 | $0.00 – $58.93 | 42,065 | 27 |
| Issaquah, WA | $55.03 | $1.84 – $110.67 | 42,088 | 107 |
| Jonesville, LA | $4.94 | $0.00 – $24.63 | 42,091 | 4 |
| Wellesley, MA | $82.88 | $0.00 – $240.02 | 42,134 | 88 |
| Fayetteville, GA | $46.93 | $0.00 – $136.11 | 42,240 | 53 |
| Luquillo, PR | $0.30 | $0.00 – $33.27 | 42,314 | 7 |
| Raton, NM | $59.83 | $0.00 – $96.89 | 42,330 | 20 |
| Fergus Falls, MN | $60.12 | $29.23 – $162.13 | 42,348 | 45 |
| Fleming Island, FL | $44.92 | $6.44 – $214.53 | 42,350 | 55 |
| Roxbury, MA | $40.61 | $0.00 – $165.49 | 42,362 | 40 |
| Salamanca, NY | $54.49 | $17.74 – $675.75 | 42,376 | 17 |
| Eloy, AZ | $95.84 | $2.81 – $662.34 | 42,389 | 11 |
| Bradley, IL | $54.25 | $22.99 – $121.00 | 42,418 | 27 |
| Ft Worth, TX | $42.66 | $0.00 – $103.38 | 42,459 | 32 |
| Cave Junction, OR | $23.92 | $0.13 – $75.65 | 42,493 | 20 |
| Hodgenville, KY | $30.65 | $18.58 – $53.95 | 42,568 | 11 |
| New Church, VA | $65.82 | $35.11 – $93.54 | 42,569 | 11 |
| Beaver, PA | $42.57 | $0.00 – $115.00 | 42,571 | 52 |
| Beaufort, NC | $31.91 | $0.11 – $53.84 | 42,581 | 12 |
| Farmington, MI | $65.08 | $25.91 – $90.29 | 42,601 | 10 |
| Franklin Square, NY | $68.37 | $0.00 – $177.10 | 42,613 | 26 |
| Jamestown, CA | $38.81 | $0.00 – $420.26 | 42,624 | 7 |
| Warrensville Heights, OH | $33.33 | $3.23 – $318.75 | 42,628 | 46 |
| Marathon, NY | $59.86 | $29.18 – $118.70 | 42,654 | 8 |
| Slingerlands, NY | $63.36 | $24.73 – $116.82 | 42,669 | 52 |
| Waupaca, WI | $36.82 | $4.13 – $141.17 | 42,717 | 48 |
| Adjuntas, PR | $8.84 | $0.00 – $50.18 | 42,803 | 14 |
| Calabash, NC | $65.54 | $0.00 – $67.23 | 42,813 | 5 |
| Mount Holly, NJ | $66.77 | $8.13 – $140.76 | 42,853 | 34 |
| Pahoa, HI | $147.54 | $33.21 – $282.39 | 42,855 | 15 |
| Ripon, CA | $5.84 | $0.87 – $5.93 | 42,884 | 2 |
| Corryton, TN | $43.05 | $8.14 – $61.24 | 42,905 | 9 |
| Cadiz, OH | $45.15 | $17.14 – $151.19 | 42,907 | 15 |
| Dunnellon, FL | $18.53 | $0.53 – $42.04 | 42,940 | 10 |
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.