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 |
|---|---|---|---|---|
| Clay, WV | $8.93 | $0.00 – $36.31 | 48,341 | 16 |
| Onawa, IA | $6.07 | $0.00 – $62.30 | 48,366 | 7 |
| Rainelle, WV | $12.12 | $0.00 – $76.84 | 48,373 | 25 |
| Greenville, IL | $21.87 | $0.02 – $62.04 | 48,382 | 15 |
| Dunmore, PA | $39.72 | $10.82 – $97.19 | 48,386 | 31 |
| Sartell, MN | $61.38 | $0.00 – $138.93 | 48,393 | 80 |
| Ft Wright, KY | $49.16 | $20.47 – $75.05 | 48,398 | 25 |
| Bastrop, TX | $38.48 | $0.00 – $161.07 | 48,434 | 43 |
| Big Spring, TX | $33.26 | $0.11 – $761.28 | 48,486 | 35 |
| Porter, ME | $2.85 | $1.46 – $37.34 | 48,510 | 3 |
| Florham Park, NJ | $50.88 | $7.31 – $196.47 | 48,526 | 40 |
| St Francis, WI | $37.23 | $4.96 – $55.58 | 48,559 | 26 |
| Taylorsville, NC | $52.20 | $0.00 – $128.10 | 48,570 | 30 |
| Brooklyn Park, MN | $83.13 | $33.43 – $150.37 | 48,572 | 68 |
| N Little Rock, AR | $29.72 | $23.25 – $49.93 | 48,582 | 3 |
| Webster City, IA | $15.60 | $0.41 – $65.57 | 48,604 | 25 |
| Bountiful, UT | $76.84 | $0.00 – $349.59 | 48,607 | 75 |
| Salem, NH | $42.30 | $0.00 – $142.30 | 48,654 | 27 |
| Springfield, KY | $32.66 | $15.46 – $38.56 | 48,667 | 16 |
| Lake St Louis, MO | $63.76 | $17.79 – $120.43 | 48,670 | 30 |
| Rainbow City, AL | $50.71 | $0.00 – $81.04 | 48,681 | 23 |
| Central Point, OR | $54.53 | $7.78 – $195.58 | 48,683 | 39 |
| Media, PA | $37.43 | $0.08 – $253.36 | 48,694 | 92 |
| Lumberton, NJ | $55.73 | $13.36 – $151.19 | 48,699 | 41 |
| North Hills, CA | $29.41 | $0.00 – $1,233 | 48,721 | 28 |
| Payson, UT | $75.10 | $1.85 – $601.63 | 48,721 | 33 |
| Hibbing, MN | $67.95 | $6.17 – $575.30 | 48,722 | 55 |
| Streetsboro, OH | $51.01 | $18.21 – $81.89 | 48,747 | 32 |
| Guerneville, CA | $3.74 | $0.00 – $620.81 | 48,750 | 14 |
| Aztec, NM | $82.04 | $60.06 – $106.85 | 48,796 | 11 |
| St Cloud, MN | $77.50 | $35.10 – $233.62 | 48,822 | 78 |
| Macon, MS | $62.09 | $21.28 – $147.08 | 48,873 | 13 |
| Whitehall, MI | $14.72 | $3.46 – $875.15 | 48,941 | 4 |
| Dade City, FL | $33.61 | $0.00 – $59.52 | 49,019 | 24 |
| Union, MO | $50.56 | $0.00 – $106.41 | 49,036 | 25 |
| Lake Forest, IL | $54.07 | $1.43 – $172.69 | 49,048 | 96 |
| Foxboro, MA | $51.20 | $5.65 – $117.29 | 49,051 | 46 |
| Thief River Falls, MN | $62.86 | $2.19 – $192.87 | 49,134 | 42 |
| Woodlawn, VA | $63.93 | $8.46 – $75.53 | 49,202 | 13 |
| Hazlet, NJ | $52.83 | $0.25 – $113.51 | 49,212 | 23 |
| Charles City, IA | $6.30 | $0.01 – $48.97 | 49,240 | 14 |
| Newport, WA | $46.10 | $0.00 – $59.25 | 49,268 | 23 |
| Travelers Rest, SC | $63.90 | $1.12 – $345.00 | 49,276 | 37 |
| Seminole, FL | $31.03 | $0.00 – $160.29 | 49,297 | 21 |
| Seneca, PA | $49.38 | $0.00 – $102.41 | 49,327 | 32 |
| Harlan, IA | $9.01 | $0.00 – $55.31 | 49,337 | 14 |
| Franklin Lakes, NJ | $83.41 | $5.56 – $93.42 | 49,338 | 8 |
| Keansburg, NJ | $90.67 | $64.60 – $166.13 | 49,372 | 3 |
| Watervliet, MI | $12.25 | $2.37 – $49.45 | 49,377 | 2 |
| Magnolia, TX | $34.05 | $0.00 – $58.31 | 49,406 | 13 |
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.