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 |
|---|---|---|---|---|
| Frankfort, IN | $54.26 | $12.13 – $89.49 | 67,634 | 30 |
| St. Louis, MO | $64.17 | $0.00 – $129.48 | 67,708 | 84 |
| Seaman, OH | $33.21 | $0.12 – $67.16 | 67,718 | 18 |
| Mayer, AZ | $61.81 | $46.09 – $84.37 | 67,749 | 8 |
| Du Quoin, IL | $14.34 | $0.00 – $89.72 | 67,789 | 17 |
| Sunnyvale, TX | $32.89 | $0.00 – $84.87 | 67,814 | 24 |
| Fort Atkinson, WI | $44.59 | $9.22 – $334.89 | 67,832 | 53 |
| La Pine, OR | $34.20 | $4.86 – $80.38 | 67,877 | 24 |
| Moscow, ID | $36.87 | $0.06 – $96.59 | 67,972 | 58 |
| Milton, WV | $11.19 | $2.19 – $68.22 | 68,022 | 6 |
| Sandpoint, ID | $52.30 | $0.00 – $116.02 | 68,034 | 61 |
| Bay Saint Louis, MS | $46.86 | $12.69 – $86.00 | 68,076 | 9 |
| Staples, MN | $190.61 | $50.42 – $745.53 | 68,078 | 61 |
| Travis Afb, CA | $54.45 | $0.00 – $375.05 | 68,093 | 55 |
| Mount Orab, OH | $28.06 | $0.00 – $54.76 | 68,107 | 24 |
| Arnold, MO | $64.85 | $1.28 – $114.61 | 68,145 | 42 |
| Decatur, TN | $36.28 | $20.83 – $73.14 | 68,184 | 11 |
| Huntsville, TN | $31.52 | $24.25 – $38.89 | 68,208 | 10 |
| Ketchikan, AK | $137.09 | $0.00 – $622.78 | 68,252 | 47 |
| Magnolia, AR | $30.28 | $0.01 – $112.60 | 68,325 | 34 |
| Mount Pleasant, SC | $59.42 | $8.72 – $160.99 | 68,334 | 64 |
| Tunkhannock, PA | $46.95 | $0.25 – $220.34 | 68,351 | 17 |
| Monroe, GA | $68.24 | $12.57 – $123.91 | 68,374 | 27 |
| Lincolnwood, IL | $45.31 | $10.00 – $81.20 | 68,391 | 25 |
| Forked River, NJ | $43.24 | $6.61 – $85.20 | 68,400 | 24 |
| Gettysburg, PA | $44.60 | $0.00 – $111.14 | 68,425 | 98 |
| Wauseon, OH | $42.89 | $12.69 – $58.93 | 68,483 | 38 |
| Winton, CA | $26.27 | $3.78 – $823.19 | 68,504 | 3 |
| Hormigueros, PR | $17.23 | $0.00 – $85.95 | 68,532 | 21 |
| Arab, AL | $9.18 | $0.00 – $54.52 | 68,563 | 9 |
| Beattyville, KY | $32.53 | $4.18 – $61.08 | 68,565 | 16 |
| Pulaski, NY | $105.94 | $24.29 – $118.32 | 68,592 | 22 |
| Chesterfield, VA | $51.98 | $2.14 – $110.92 | 68,623 | 38 |
| Collierville, TN | $50.68 | $1.30 – $102.99 | 68,652 | 50 |
| Burbank, IL | $55.54 | $16.85 – $96.12 | 68,688 | 27 |
| Battle Ground, WA | $41.07 | $3.79 – $229.96 | 68,791 | 41 |
| Elkhorn, NE | $58.54 | $11.16 – $170.44 | 68,797 | 61 |
| Payson, AZ | $45.14 | $0.22 – $262.87 | 68,826 | 49 |
| Coram, NY | $72.24 | $4.47 – $127.97 | 68,852 | 22 |
| Hinton, WV | $21.89 | $0.00 – $70.02 | 68,963 | 18 |
| Three Rivers, MI | $19.60 | $4.93 – $72.74 | 69,037 | 16 |
| Moulton, AL | $27.19 | $0.00 – $231.97 | 69,044 | 16 |
| Ladson, SC | $58.12 | $14.20 – $142.04 | 69,061 | 36 |
| Garfield Hts, OH | $37.50 | $8.63 – $110.50 | 69,069 | 40 |
| St. Francisville, LA | $43.01 | $20.76 – $66.93 | 69,075 | 9 |
| Pleasant Hill, IA | $38.30 | $5.93 – $40.55 | 69,078 | 21 |
| East Saint Louis, IL | $5.98 | $0.00 – $60.08 | 69,103 | 18 |
| Neosho, MO | $98.00 | $10.79 – $196.83 | 69,173 | 40 |
| Avon Park, FL | $15.08 | $0.00 – $99.20 | 69,180 | 30 |
| San Marcos, TX | $46.10 | $0.00 – $250.87 | 69,208 | 62 |
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.