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 |
|---|---|---|---|---|
| Norwell, MA | $50.53 | $0.09 – $102.87 | 59,574 | 81 |
| Ozark, MO | $69.37 | $16.20 – $136.46 | 59,591 | 54 |
| Norco, CA | $21.38 | $0.00 – $435.09 | 59,629 | 20 |
| Williston Park, NY | $87.22 | $41.37 – $105.88 | 59,658 | 13 |
| Ferriday, LA | $13.68 | $0.00 – $50.72 | 59,686 | 17 |
| North Olmsted, OH | $53.97 | $0.00 – $134.47 | 59,705 | 30 |
| Covington, VA | $59.23 | $0.00 – $80.23 | 59,739 | 19 |
| Lansdale, PA | $48.61 | $0.00 – $97.13 | 59,742 | 63 |
| Nevada, MO | $57.80 | $1.36 – $166.77 | 59,778 | 33 |
| Ocean City, MD | $96.42 | $0.53 – $120.96 | 59,784 | 16 |
| Atmore, AL | $24.18 | $0.00 – $219.28 | 59,785 | 17 |
| Polacca, AZ | $441.63 | $17.20 – $457.49 | 59,815 | 7 |
| Ronkonkoma, NY | $67.02 | $3.20 – $146.43 | 59,836 | 27 |
| Lake Placid, FL | $45.79 | $6.41 – $67.22 | 59,964 | 10 |
| West Melbourne, FL | $73.74 | $0.00 – $96.61 | 59,969 | 10 |
| Pleasant Grove, UT | $43.15 | $19.12 – $94.56 | 59,971 | 38 |
| Bunkie, LA | $7.21 | $0.00 – $21.51 | 59,977 | 10 |
| Jasper, TX | $51.81 | $0.00 – $435.30 | 60,096 | 13 |
| Loudon, TN | $50.54 | $0.00 – $82.93 | 60,101 | 19 |
| Rochester, NH | $43.03 | $0.00 – $117.41 | 60,119 | 48 |
| Wrightsville, GA | $69.80 | $69.19 – $94.38 | 60,124 | 3 |
| Hamlin, WV | $18.42 | $0.00 – $66.44 | 60,164 | 15 |
| Magna, UT | $64.03 | $7.66 – $113.77 | 60,180 | 22 |
| Princess Anne, MD | $119.03 | $7.18 – $215.54 | 60,182 | 23 |
| Montezuma Creek, UT | $371.52 | $3.02 – $511.83 | 60,185 | 11 |
| Fort Mohave, AZ | $49.31 | $0.00 – $72.89 | 60,198 | 22 |
| Fort Scott, KS | $130.53 | $2.13 – $230.79 | 60,203 | 29 |
| Ozark, AL | $81.29 | $5.81 – $222.76 | 60,238 | 17 |
| Eupora, MS | $72.58 | $0.00 – $160.23 | 60,241 | 20 |
| Moultrie, GA | $88.95 | $0.59 – $119.74 | 60,258 | 21 |
| Ludlow, MA | $56.17 | $12.30 – $115.81 | 60,305 | 26 |
| Arkansas City, KS | $90.15 | $12.52 – $203.86 | 60,358 | 25 |
| Tama, IA | $3.29 | $0.01 – $219.62 | 60,375 | 11 |
| Easthampton, MA | $48.11 | $3.94 – $110.66 | 60,379 | 25 |
| Solon, OH | $50.05 | $7.78 – $107.22 | 60,398 | 50 |
| Powell, OH | $54.41 | $8.14 – $134.50 | 60,407 | 41 |
| Lincoln City, OR | $51.54 | $0.00 – $123.00 | 60,424 | 51 |
| Rifle, CO | $193.83 | $0.00 – $402.92 | 60,446 | 42 |
| Hilmar, CA | $7.51 | $1.91 – $644.02 | 60,475 | 7 |
| Carthage, IL | $4.94 | $0.01 – $69.82 | 60,503 | 8 |
| Franklin, VA | $54.75 | $14.01 – $93.61 | 60,567 | 35 |
| Newport, ME | $21.17 | $7.87 – $117.14 | 60,651 | 8 |
| Charlestown, IN | $55.98 | $12.28 – $208.92 | 60,710 | 16 |
| Wilbraham, MA | $47.94 | $8.18 – $78.56 | 60,721 | 33 |
| Parkville, MD | $92.13 | $0.00 – $165.53 | 60,762 | 42 |
| Kamuela, HI | $67.49 | $2.32 – $205.00 | 60,810 | 50 |
| Westampton, NJ | $67.01 | $0.00 – $119.62 | 60,821 | 29 |
| Supply, NC | $61.63 | $21.97 – $154.33 | 60,846 | 28 |
| Oakland Park, FL | $39.66 | $0.00 – $134.94 | 60,851 | 49 |
| Waverly, TN | $41.20 | $3.33 – $75.87 | 60,923 | 19 |
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.