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 |
|---|---|---|---|---|
| Douglasville, GA | $54.34 | $0.00 – $131.05 | 55,128 | 37 |
| Lander, WY | $42.13 | $0.00 – $83.55 | 55,176 | 55 |
| Midvale, UT | $74.36 | $16.30 – $214.46 | 55,177 | 23 |
| Watertown, WI | $36.05 | $0.00 – $71.81 | 55,192 | 48 |
| Okatie, SC | $89.49 | $2.68 – $250.27 | 55,216 | 25 |
| Somerville, NJ | $46.01 | $0.00 – $131.96 | 55,224 | 47 |
| Pawleys Island, SC | $66.08 | $5.27 – $106.88 | 55,227 | 36 |
| Thermal, CA | $5.44 | $0.43 – $32.07 | 55,240 | 8 |
| Detroit Lakes, MN | $72.29 | $26.60 – $203.01 | 55,422 | 72 |
| Amery, WI | $47.40 | $7.50 – $302.80 | 55,430 | 40 |
| Pocahontas, AR | $32.16 | $0.00 – $43.40 | 55,444 | 25 |
| Rutherford, NJ | $53.24 | $2.01 – $150.83 | 55,451 | 39 |
| American Fork, UT | $50.69 | $0.00 – $127.30 | 55,529 | 73 |
| Salem, NJ | $25.11 | $0.16 – $97.71 | 55,534 | 12 |
| Brownsburg, IN | $57.35 | $4.63 – $121.33 | 55,538 | 54 |
| Moorefield, WV | $9.11 | $0.00 – $52.28 | 55,567 | 19 |
| Carol Stream, IL | $44.05 | $0.00 – $124.42 | 55,614 | 31 |
| Wiggins, MS | $61.67 | $4.84 – $104.27 | 55,616 | 20 |
| Pittston, PA | $41.92 | $11.98 – $106.93 | 55,650 | 25 |
| Menasha, WI | $23.82 | $10.19 – $114.04 | 55,704 | 50 |
| Taylorsville, UT | $60.98 | $0.00 – $128.22 | 55,767 | 42 |
| Anthem, AZ | $78.16 | $16.74 – $124.52 | 55,772 | 32 |
| Painted Post, NY | $73.70 | $0.00 – $114.42 | 55,789 | 12 |
| Guilford, CT | $45.74 | $0.00 – $96.00 | 55,789 | 76 |
| Celebration, FL | $53.85 | $0.00 – $563.14 | 55,808 | 71 |
| Princeton, NJ | $56.28 | $0.00 – $187.97 | 55,812 | 71 |
| Onley, VA | $60.38 | $9.96 – $127.66 | 55,821 | 21 |
| Cankton, LA | $2.83 | $0.00 – $6.27 | 55,822 | 6 |
| Fredericktown, PA | $0.08 | $0.00 – $11.82 | 55,842 | 6 |
| Liberty Twp, OH | $51.88 | $17.92 – $65.43 | 55,847 | 16 |
| Grafton, WV | $21.95 | $0.00 – $78.32 | 55,901 | 21 |
| Bay Minette, AL | $60.95 | $0.00 – $90.23 | 55,901 | 32 |
| Orange, NJ | $44.76 | $1.58 – $102.24 | 55,912 | 20 |
| Bay St Louis, MS | $52.75 | $1.10 – $105.39 | 55,914 | 37 |
| Chipley, FL | $23.08 | $5.80 – $76.32 | 55,983 | 21 |
| Cambridge, MN | $84.92 | $18.73 – $199.25 | 55,995 | 60 |
| Fairview Park, OH | $30.70 | $12.29 – $67.24 | 56,076 | 28 |
| New Richmond, OH | $23.25 | $0.47 – $31.59 | 56,082 | 9 |
| Mullens, WV | $7.43 | $0.00 – $41.34 | 56,091 | 5 |
| Union Gap, WA | $49.47 | $41.95 – $65.82 | 56,096 | 13 |
| White Cloud, MI | $117.47 | $3.40 – $279.03 | 56,149 | 6 |
| Baxter, MN | $67.98 | $9.39 – $208.05 | 56,174 | 64 |
| Petersburg, IN | $53.88 | $40.02 – $71.06 | 56,191 | 13 |
| Osceola, IA | $18.17 | $0.00 – $337.63 | 56,212 | 19 |
| Clinton, MS | $51.81 | $0.00 – $149.09 | 56,219 | 33 |
| Shasta Lake, CA | $0.90 | $0.00 – $57.00 | 56,257 | 6 |
| Woodville, MS | $75.16 | $30.46 – $130.40 | 56,314 | 7 |
| Troy, NC | $43.79 | $5.33 – $74.82 | 56,323 | 13 |
| New Smyrna Beach, FL | $51.81 | $0.00 – $103.23 | 56,341 | 35 |
| Breese, IL | $18.27 | $0.57 – $74.81 | 56,373 | 16 |
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.