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 |
|---|---|---|---|---|
| La Grange Park, IL | $19.81 | $0.01 – $83.93 | 60,954 | 7 |
| Mountain View, AR | $34.86 | $0.00 – $60.52 | 61,000 | 23 |
| Sunset, LA | $30.50 | $21.80 – $42.39 | 61,011 | 8 |
| Montrose, CA | $4.43 | $0.00 – $111.42 | 61,043 | 17 |
| Hockessin, DE | $37.37 | $0.00 – $69.86 | 61,069 | 16 |
| Marion, NC | $47.90 | $0.00 – $143.34 | 61,114 | 42 |
| San Marino, CA | $17.15 | $0.37 – $138.51 | 61,141 | 16 |
| Houghton, MI | $99.92 | $23.45 – $379.22 | 61,178 | 8 |
| Dix Hills, NY | $80.54 | $2.95 – $258.08 | 61,194 | 14 |
| Harrisburg, NC | $62.35 | $7.13 – $150.17 | 61,236 | 48 |
| Madison, MS | $45.34 | $0.00 – $150.14 | 61,239 | 69 |
| Leon, IA | $4.67 | $0.00 – $75.66 | 61,258 | 10 |
| Kenai, AK | $153.15 | $0.00 – $573.68 | 61,267 | 43 |
| Marks, MS | $47.72 | $12.08 – $129.57 | 61,276 | 10 |
| Piketon, OH | $33.89 | $0.00 – $113.41 | 61,281 | 9 |
| Gainesville, VA | $55.59 | $17.29 – $109.77 | 61,318 | 54 |
| Clifton Springs, NY | $102.24 | $11.22 – $121.42 | 61,366 | 30 |
| White Salmon, WA | $45.54 | $1.55 – $182.81 | 61,367 | 32 |
| Prattville, AL | $44.12 | $0.00 – $231.21 | 61,370 | 38 |
| Waterford, CT | $35.05 | $0.00 – $79.39 | 61,399 | 53 |
| Page, AZ | $21.72 | $0.00 – $123.71 | 61,415 | 16 |
| Hopewell Junction, NY | $77.63 | $26.78 – $151.22 | 61,424 | 39 |
| Waynesboro, TN | $30.13 | $13.08 – $42.11 | 61,480 | 15 |
| Tuba City, AZ | $91.68 | $0.00 – $285.78 | 61,497 | 41 |
| Hays, KS | $57.23 | $0.00 – $249.30 | 61,499 | 85 |
| Lauderhill, FL | $20.13 | $0.00 – $90.56 | 61,510 | 21 |
| Hoopeston, IL | $3.77 | $0.00 – $66.08 | 61,516 | 8 |
| Longmeadow, MA | $55.54 | $0.00 – $134.31 | 61,535 | 43 |
| South River, NJ | $7.75 | $3.40 – $45.71 | 61,547 | 4 |
| South San Francisco, CA | $12.92 | $0.00 – $283.95 | 61,570 | 45 |
| Fayette, MS | $51.64 | $5.41 – $116.52 | 61,655 | 14 |
| Frankfort, IL | $67.66 | $0.13 – $319.37 | 61,677 | 31 |
| Parker, AZ | $26.61 | $0.03 – $94.24 | 61,792 | 33 |
| Oak Brook, IL | $64.14 | $0.00 – $275.73 | 61,815 | 40 |
| Harrodsburg, KY | $34.49 | $15.72 – $46.65 | 61,839 | 31 |
| Washington, IA | $3.08 | $0.00 – $52.11 | 61,844 | 31 |
| Carmi, IL | $0.29 | $0.00 – $49.22 | 61,875 | 8 |
| Waxhaw, NC | $66.48 | $0.00 – $86.39 | 61,941 | 31 |
| La Puente, CA | $33.78 | $0.00 – $476.95 | 61,949 | 31 |
| Hazle Township, PA | $32.40 | $0.00 – $84.61 | 61,998 | 34 |
| Potosi, MO | $76.84 | $17.65 – $116.95 | 62,002 | 28 |
| Cairo, IL | $6.17 | $0.60 – $44.80 | 62,004 | 4 |
| Wabash, IN | $55.27 | $0.00 – $72.55 | 62,017 | 38 |
| Eagle Butte, SD | $354.32 | $40.72 – $544.52 | 62,104 | 10 |
| Maplewood, MN | $71.96 | $2.79 – $117.60 | 62,116 | 135 |
| Abington, PA | $39.66 | $0.00 – $135.62 | 62,123 | 97 |
| Winfield, AL | $32.80 | $0.00 – $73.11 | 62,124 | 23 |
| Willoughby Hills, OH | $50.67 | $10.03 – $134.13 | 62,171 | 39 |
| Kerrville, TX | $54.38 | $0.94 – $574.67 | 62,185 | 64 |
| Aliquippa, PA | $50.97 | $0.00 – $102.79 | 62,222 | 32 |
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.