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 |
|---|---|---|---|---|
| Hancock, MI | $41.51 | $0.00 – $187.97 | 47,107 | 15 |
| Cape Carteret, NC | $66.18 | $42.30 – $102.38 | 47,110 | 8 |
| College Park, MD | $81.74 | $12.48 – $156.85 | 47,122 | 29 |
| Trenton, FL | $34.98 | $4.49 – $59.66 | 47,151 | 20 |
| West Long Branch, NJ | $60.96 | $0.00 – $110.13 | 47,172 | 25 |
| Water Valley, MS | $59.64 | $11.43 – $144.01 | 47,174 | 17 |
| Mount Dora, FL | $50.69 | $5.79 – $112.54 | 47,184 | 28 |
| Clementon, NJ | $60.48 | $0.00 – $85.64 | 47,277 | 7 |
| West Portsmouth, OH | $43.64 | $0.03 – $67.45 | 47,279 | 8 |
| South Yarmouth, MA | $50.77 | $18.01 – $96.57 | 47,287 | 19 |
| Upper Sandusky, OH | $40.35 | $9.40 – $102.24 | 47,289 | 31 |
| Williston, VT | $26.29 | $0.00 – $117.43 | 47,305 | 62 |
| Dallas, OR | $52.85 | $0.31 – $396.17 | 47,326 | 33 |
| Gilbert, WV | $10.81 | $0.00 – $19.02 | 47,330 | 6 |
| Smithfield, RI | $59.36 | $28.06 – $94.65 | 47,336 | 35 |
| Lehi, UT | $58.63 | $0.00 – $194.04 | 47,337 | 60 |
| Zwolle, LA | $0.41 | $0.02 – $0.99 | 47,394 | 5 |
| Downingtown, PA | $57.39 | $2.19 – $111.80 | 47,399 | 24 |
| Lincolnshire, IL | $51.16 | $5.22 – $111.42 | 47,416 | 35 |
| Gambrills, MD | $122.56 | $0.00 – $143.62 | 47,533 | 21 |
| Shrewsbury, MA | $67.55 | $4.10 – $179.85 | 47,551 | 50 |
| Algonquin, IL | $53.94 | $9.21 – $129.47 | 47,600 | 40 |
| Ronan, MT | $23.38 | $0.00 – $479.00 | 47,616 | 22 |
| Pagosa Springs, CO | $113.15 | $3.44 – $228.58 | 47,657 | 34 |
| Laramie, WY | $56.31 | $0.44 – $83.49 | 47,671 | 56 |
| Greenwell Springs, LA | $29.50 | $0.03 – $71.76 | 47,681 | 15 |
| Hartsdale, NY | $93.38 | $33.94 – $192.16 | 47,700 | 40 |
| Palatine, IL | $53.78 | $0.00 – $287.07 | 47,743 | 22 |
| Castaner, PR | $3.34 | $0.00 – $8.68 | 47,745 | 9 |
| New Brighton, MN | $84.85 | $48.64 – $127.81 | 47,757 | 32 |
| Atoka, TN | $39.61 | $15.26 – $57.14 | 47,760 | 17 |
| Swartz Creek, MI | $77.53 | $68.92 – $77.90 | 47,763 | 4 |
| Dixon, CA | $5.67 | $3.50 – $53.06 | 47,764 | 6 |
| Bay City, TX | $49.38 | $0.00 – $156.57 | 47,767 | 32 |
| Menlo Park, CA | $17.55 | $0.00 – $146.94 | 47,783 | 31 |
| Fruita, CO | $63.96 | $29.03 – $120.09 | 47,835 | 58 |
| Fulton, MO | $59.36 | $2.08 – $92.11 | 47,849 | 25 |
| Malta, OH | $16.37 | $0.63 – $39.30 | 47,858 | 8 |
| Winder, GA | $101.74 | $7.53 – $853.05 | 47,938 | 16 |
| Forest, VA | $68.34 | $14.81 – $143.07 | 48,010 | 49 |
| Mountlake Terrace, WA | $85.48 | $0.00 – $268.46 | 48,097 | 27 |
| Wallington, NJ | $63.95 | $0.46 – $74.62 | 48,118 | 11 |
| Villa Rica, GA | $58.30 | $0.00 – $74.25 | 48,150 | 37 |
| Grove City, PA | $55.77 | $6.34 – $79.10 | 48,154 | 35 |
| Streator, IL | $24.18 | $0.00 – $79.64 | 48,192 | 15 |
| Florence, OR | $65.82 | $30.38 – $197.21 | 48,266 | 41 |
| Willard, OH | $41.39 | $26.77 – $67.77 | 48,273 | 21 |
| Feasterville Trevose, PA | $41.44 | $0.00 – $81.15 | 48,275 | 24 |
| Mays Landing, NJ | $56.87 | $0.00 – $122.93 | 48,283 | 21 |
| Bay Springs, MS | $54.37 | $6.47 – $109.35 | 48,338 | 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.