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 |
|---|---|---|---|---|
| Thomasville, GA | $52.97 | $0.32 – $122.56 | 42,943 | 28 |
| Peru, IL | $40.38 | $0.00 – $97.92 | 42,969 | 32 |
| Cave City, KY | $46.56 | $28.03 – $56.63 | 43,044 | 6 |
| Florida, PR | $9.93 | $0.00 – $10.51 | 43,044 | 4 |
| Louisburg, NC | $55.00 | $24.85 – $114.49 | 43,047 | 19 |
| Hyde Park, MA | $43.17 | $1.46 – $86.74 | 43,078 | 22 |
| Van Buren Twp, MI | $59.84 | $59.02 – $60.25 | 43,085 | 2 |
| Florence, MS | $75.21 | $6.16 – $102.68 | 43,098 | 15 |
| Angier, NC | $72.49 | $41.04 – $79.01 | 43,112 | 10 |
| Eldersburg, MD | $101.09 | $0.00 – $377.76 | 43,154 | 47 |
| Boiling Springs, SC | $61.78 | $8.72 – $186.35 | 43,176 | 22 |
| Farrell, PA | $37.74 | $0.00 – $67.45 | 43,211 | 26 |
| New Hudson, MI | $63.71 | $63.45 – $85.03 | 43,231 | 2 |
| Diamondhead, MS | $55.33 | $9.94 – $83.52 | 43,233 | 21 |
| Prospect, CT | $50.06 | $0.00 – $81.87 | 43,243 | 22 |
| Roscoe, IL | $44.59 | $0.00 – $82.15 | 43,252 | 29 |
| Pennsville, NJ | $59.13 | $0.25 – $139.65 | 43,275 | 10 |
| Oak Harbor, WA | $51.95 | $0.10 – $99.11 | 43,322 | 36 |
| Belle Glade, FL | $59.34 | $6.54 – $191.49 | 43,364 | 22 |
| Helena, AR | $31.37 | $9.80 – $37.86 | 43,376 | 19 |
| Cortlandt Manor, NY | $91.95 | $0.00 – $183.81 | 43,385 | 56 |
| Weimar, CA | $2.64 | $0.00 – $10.92 | 43,404 | 9 |
| Princeton, IL | $12.95 | $0.00 – $87.14 | 43,407 | 18 |
| Geneva, IL | $54.01 | $0.00 – $165.01 | 43,409 | 74 |
| Nashville, NC | $46.41 | $29.04 – $61.07 | 43,417 | 16 |
| White House, TN | $40.33 | $0.00 – $59.37 | 43,420 | 26 |
| Grayslake, IL | $52.48 | $0.00 – $99.64 | 43,502 | 41 |
| Port Hueneme, CA | $24.21 | $7.96 – $72.19 | 43,546 | 7 |
| La Grange, IL | $54.15 | $11.28 – $317.18 | 43,576 | 23 |
| Kodiak, AK | $204.09 | $0.00 – $692.27 | 43,595 | 29 |
| Sisseton, SD | $165.33 | $0.00 – $873.46 | 43,613 | 22 |
| Westfield, IN | $59.53 | $18.51 – $111.85 | 43,648 | 43 |
| Merrill, WI | $83.38 | $11.53 – $174.48 | 43,650 | 25 |
| Washington, LA | $19.42 | $0.00 – $34.43 | 43,663 | 5 |
| Stoughton, WI | $106.37 | $9.29 – $152.75 | 43,676 | 32 |
| Madison, OH | $50.97 | $13.17 – $66.47 | 43,690 | 20 |
| Georgetown, IL | $0.00 | $0.00 – $0.00 | 43,702 | 1 |
| Trotwood, OH | $53.15 | $39.02 – $64.17 | 43,749 | 7 |
| Port Clinton, OH | $37.91 | $6.45 – $52.71 | 43,760 | 18 |
| Warrenville, IL | $49.98 | $10.33 – $97.20 | 43,773 | 50 |
| Davidson, NC | $65.53 | $9.89 – $318.75 | 43,827 | 38 |
| Buttonwillow, CA | $23.63 | $20.87 – $24.99 | 43,829 | 2 |
| Cartersville, GA | $48.76 | $1.47 – $82.34 | 43,838 | 25 |
| Kearney, NJ | $52.63 | $52.63 – $52.63 | 43,857 | 1 |
| Montour Falls, NY | $120.00 | $13.10 – $199.48 | 43,861 | 13 |
| Northglenn, CO | $63.21 | $0.00 – $116.12 | 43,864 | 38 |
| Prairie Du Chien, WI | $84.33 | $16.02 – $181.56 | 43,872 | 29 |
| Danville, IN | $56.05 | $7.17 – $92.03 | 43,878 | 77 |
| Stoughton, MA | $58.82 | $2.48 – $118.32 | 43,913 | 38 |
| Port Royal, SC | $84.85 | $31.21 – $235.10 | 43,918 | 20 |
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.