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 |
|---|---|---|---|---|
| Malta, NY | $170.29 | $29.18 – $189.70 | 49,414 | 12 |
| Springville, AL | $15.44 | $0.14 – $73.44 | 49,441 | 11 |
| Athol, MA | $136.10 | $3.96 – $401.59 | 49,466 | 23 |
| Indian River, MI | $28.68 | $9.13 – $86.99 | 49,489 | 4 |
| Belle Chasse, LA | $29.24 | $0.00 – $66.22 | 49,538 | 14 |
| Mililani, HI | $47.09 | $0.00 – $162.87 | 49,552 | 34 |
| Granville, OH | $59.38 | $0.00 – $120.28 | 49,576 | 30 |
| Fort Morgan, CO | $84.91 | $0.00 – $394.98 | 49,590 | 29 |
| Munford, TN | $37.79 | $6.73 – $62.36 | 49,636 | 12 |
| Haddon Heights, NJ | $71.64 | $0.00 – $296.76 | 49,647 | 66 |
| Wapakoneta, OH | $42.95 | $22.40 – $84.46 | 49,649 | 30 |
| Hope, AR | $51.68 | $1.04 – $68.71 | 49,676 | 18 |
| Erlanger, KY | $31.18 | $2.16 – $161.71 | 49,813 | 32 |
| Harrison, OH | $32.21 | $3.59 – $66.16 | 49,819 | 22 |
| Niantic, CT | $61.32 | $8.05 – $113.43 | 49,823 | 24 |
| Rockport, IN | $39.37 | $22.64 – $65.76 | 49,848 | 10 |
| Jasper, GA | $54.45 | $12.80 – $76.08 | 49,860 | 26 |
| North Quincy, MA | $6.54 | $0.00 – $165.49 | 49,882 | 28 |
| Pinole, CA | $20.35 | $0.11 – $136.09 | 49,901 | 25 |
| Coudersport, PA | $16.40 | $0.00 – $86.93 | 49,907 | 20 |
| Cherokee, IA | $14.54 | $0.00 – $54.48 | 49,928 | 20 |
| Sun City, CA | $94.86 | $0.00 – $116.35 | 49,967 | 11 |
| Irwin, PA | $56.01 | $18.55 – $88.68 | 49,977 | 40 |
| New London, WI | $40.15 | $1.60 – $100.59 | 49,980 | 37 |
| Stoneham, MA | $46.11 | $0.00 – $107.33 | 49,984 | 78 |
| Saint Augustine, FL | $48.62 | $1.40 – $89.33 | 49,994 | 30 |
| Belen, NM | $77.47 | $4.97 – $173.07 | 50,015 | 26 |
| Mt. Orab, OH | $20.71 | $0.33 – $48.34 | 50,044 | 5 |
| Manchester, IA | $3.26 | $0.00 – $51.65 | 50,048 | 38 |
| Decatur, TX | $33.23 | $0.00 – $442.95 | 50,059 | 46 |
| Madisonville, TN | $37.49 | $13.71 – $53.44 | 50,062 | 23 |
| North Kingstown, RI | $49.83 | $0.02 – $77.61 | 50,115 | 34 |
| Baraboo, WI | $36.92 | $6.49 – $73.43 | 50,147 | 47 |
| Daleville, VA | $68.06 | $3.64 – $115.95 | 50,169 | 27 |
| Stigler, OK | $125.40 | $14.95 – $615.75 | 50,218 | 23 |
| Mena, AR | $42.87 | $2.12 – $299.46 | 50,245 | 31 |
| Carthage, TN | $40.57 | $19.43 – $61.71 | 50,302 | 14 |
| Minnetonka, MN | $75.89 | $4.23 – $667.25 | 50,312 | 129 |
| Chatsworth, CA | $112.34 | $0.00 – $1,157 | 50,315 | 19 |
| Whitefish, MT | $88.30 | $0.00 – $134.94 | 50,319 | 39 |
| Beaver Dam, KY | $37.08 | $0.00 – $51.57 | 50,324 | 22 |
| Fenton, MO | $60.71 | $9.64 – $114.90 | 50,331 | 74 |
| Sallisaw, OK | $81.18 | $23.11 – $578.35 | 50,341 | 25 |
| Louisa, VA | $60.62 | $2.95 – $78.72 | 50,370 | 19 |
| Grinnell, IA | $20.78 | $0.00 – $53.37 | 50,379 | 29 |
| Bayville, NJ | $83.37 | $7.82 – $107.87 | 50,393 | 8 |
| Lenexa, KS | $45.84 | $10.19 – $176.29 | 50,398 | 62 |
| Wellsboro, PA | $40.07 | $0.00 – $67.91 | 50,468 | 22 |
| Northbrook, IL | $42.50 | $0.72 – $106.92 | 50,489 | 39 |
| Calumet City, IL | $51.89 | $0.00 – $231.05 | 50,530 | 25 |
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.