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 |
|---|---|---|---|---|
| Saltville, VA | $55.76 | $21.48 – $83.27 | 46,158 | 17 |
| Borrego Springs, CA | $4.97 | $0.96 – $50.93 | 46,161 | 7 |
| Cleveland Heights, OH | $41.92 | $0.89 – $100.60 | 46,164 | 38 |
| Bedford, TX | $42.42 | $0.00 – $199.71 | 46,171 | 42 |
| Edgewood, NM | $79.69 | $17.90 – $134.88 | 46,173 | 23 |
| Dillingham, AK | $238.27 | $0.00 – $558.02 | 46,173 | 40 |
| Algona, IA | $4.98 | $0.00 – $57.72 | 46,176 | 10 |
| Hazelwood, MO | $70.71 | $21.05 – $101.64 | 46,232 | 27 |
| Brownsville, KY | $32.42 | $5.19 – $54.22 | 46,244 | 14 |
| Box Elder, MT | $2.77 | $1.24 – $67.75 | 46,268 | 5 |
| Malvern, AR | $32.83 | $0.00 – $59.94 | 46,268 | 28 |
| Lexington, NE | $78.95 | $16.02 – $170.50 | 46,271 | 24 |
| Enumclaw, WA | $58.79 | $7.89 – $114.05 | 46,288 | 41 |
| Everett, MA | $38.51 | $0.00 – $120.75 | 46,339 | 37 |
| Maple Valley, WA | $55.63 | $31.33 – $103.18 | 46,346 | 33 |
| Spanish Fork, UT | $49.81 | $12.79 – $89.53 | 46,359 | 37 |
| Knoxville, IA | $31.52 | $0.00 – $38.44 | 46,390 | 18 |
| Ibapah, UT | $499.06 | $499.06 – $499.06 | 46,399 | 1 |
| Stilwell, OK | $70.04 | $16.98 – $190.70 | 46,401 | 17 |
| Luray, VA | $63.16 | $5.39 – $78.77 | 46,449 | 28 |
| Warsaw, MO | $61.44 | $15.90 – $163.62 | 46,452 | 21 |
| Baldwin, MI | $9.45 | $2.62 – $518.91 | 46,483 | 6 |
| Oakhurst, NJ | $59.78 | $1.91 – $123.49 | 46,545 | 22 |
| Rehoboth Beach, DE | $50.68 | $0.00 – $110.44 | 46,554 | 37 |
| Peterborough, NH | $34.49 | $5.89 – $599.79 | 46,571 | 33 |
| Kyle, TX | $39.67 | $0.00 – $115.58 | 46,593 | 65 |
| Lithonia, GA | $61.15 | $0.00 – $91.07 | 46,628 | 21 |
| Sparta, IL | $2.90 | $0.01 – $95.47 | 46,647 | 8 |
| Defuniak Springs, FL | $35.44 | $0.00 – $110.75 | 46,670 | 23 |
| Huntingdon, PA | $42.77 | $0.00 – $73.11 | 46,696 | 33 |
| Morrison, IL | $9.51 | $0.03 – $63.29 | 46,725 | 14 |
| Wendell, NC | $81.90 | $0.00 – $885.94 | 46,756 | 12 |
| Jackson, CA | $46.92 | $0.00 – $450.09 | 46,775 | 26 |
| Richland, MO | $72.47 | $47.83 – $124.99 | 46,776 | 10 |
| Brooklyn Center, MN | $71.23 | $11.91 – $207.62 | 46,780 | 57 |
| Grant, MI | $3.22 | $2.87 – $7.11 | 46,786 | 4 |
| Westlake Village, CA | $31.97 | $0.00 – $188.00 | 46,821 | 38 |
| Riverton, UT | $61.21 | $5.60 – $166.67 | 46,833 | 70 |
| Rio Rico, AZ | $3.74 | $0.03 – $41.18 | 46,853 | 3 |
| Neon, KY | $37.45 | $4.64 – $37.57 | 46,856 | 3 |
| Utuado, PR | $10.87 | $0.00 – $73.13 | 46,860 | 24 |
| Union, SC | $57.60 | $23.09 – $110.19 | 46,872 | 27 |
| Brooklyn, OH | $55.79 | $6.85 – $184.79 | 46,875 | 20 |
| Riverside, IL | $42.60 | $1.24 – $78.80 | 46,881 | 17 |
| Avenal, CA | $0.47 | $0.00 – $5.99 | 46,922 | 10 |
| Berwick, PA | $34.52 | $21.16 – $63.95 | 46,924 | 15 |
| Waverly, NY | $70.98 | $68.21 – $84.17 | 46,926 | 2 |
| Inman, SC | $79.71 | $44.66 – $170.29 | 47,011 | 17 |
| Key West, FL | $69.60 | $0.00 – $230.49 | 47,041 | 47 |
| Richfield, UT | $60.70 | $3.24 – $80.53 | 47,091 | 24 |
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.