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 |
|---|---|---|---|---|
| Clanton, AL | $76.30 | $0.00 – $241.42 | 71,066 | 30 |
| Petal, MS | $64.55 | $10.77 – $139.16 | 71,082 | 30 |
| Santa Rosa, NM | $18.77 | $2.88 – $143.90 | 71,175 | 10 |
| Evergreen, AL | $42.52 | $0.02 – $231.15 | 71,327 | 13 |
| Johnstown, CO | $65.44 | $21.39 – $87.73 | 71,418 | 35 |
| Vivian, LA | $0.06 | $0.00 – $37.53 | 71,568 | 7 |
| Highland Park, MI | $70.12 | $30.33 – $104.82 | 71,575 | 6 |
| Emporia, VA | $44.50 | $12.90 – $97.04 | 71,597 | 19 |
| Fort Defiance, AZ | $56.83 | $0.00 – $673.30 | 71,620 | 79 |
| Southampton, NY | $83.93 | $0.00 – $184.64 | 71,633 | 45 |
| Jasper, TN | $41.03 | $8.80 – $64.84 | 71,642 | 20 |
| Jackson, GA | $49.10 | $0.00 – $75.87 | 71,779 | 9 |
| Cottage Grove, OR | $66.25 | $16.24 – $147.64 | 71,794 | 27 |
| Scottsburg, IN | $50.66 | $16.02 – $73.52 | 71,833 | 24 |
| Lewisburg, TN | $38.89 | $2.17 – $65.34 | 71,834 | 40 |
| Pikeville, TN | $34.96 | $23.90 – $54.79 | 71,901 | 17 |
| Libby, MT | $5.52 | $0.00 – $92.50 | 71,945 | 12 |
| Ridgefield, CT | $72.43 | $4.19 – $111.52 | 71,996 | 35 |
| Ringgold, GA | $53.92 | $8.02 – $73.90 | 72,008 | 25 |
| Euclid, OH | $38.27 | $9.62 – $95.37 | 72,015 | 64 |
| Mount Airy, MD | $71.11 | $0.00 – $120.29 | 72,027 | 21 |
| Centerville, IA | $17.81 | $0.00 – $66.02 | 72,030 | 24 |
| Glenview, IL | $49.35 | $4.08 – $110.51 | 72,116 | 116 |
| Anaconda, MT | $58.07 | $0.00 – $161.81 | 72,125 | 38 |
| Shelby Twp, MI | $59.99 | $0.00 – $70.12 | 72,135 | 7 |
| Piqua, OH | $61.29 | $19.52 – $129.84 | 72,157 | 40 |
| Millsboro, DE | $56.57 | $0.00 – $394.15 | 72,179 | 37 |
| Camden, AR | $40.41 | $14.65 – $61.90 | 72,213 | 25 |
| Lame Deer, MT | $1.41 | $0.00 – $65.38 | 72,234 | 3 |
| Amite, LA | $13.67 | $0.00 – $45.86 | 72,241 | 23 |
| Dodge City, KS | $53.28 | $0.00 – $259.85 | 72,256 | 43 |
| Harahan, LA | $29.93 | $2.40 – $96.79 | 72,282 | 11 |
| West Paterson, NJ | $49.57 | $3.59 – $84.46 | 72,314 | 13 |
| Pismo Beach, CA | $72.84 | $0.00 – $320.20 | 72,394 | 32 |
| Marshall, MN | $105.71 | $6.09 – $260.88 | 72,402 | 62 |
| New Richmond, WI | $54.43 | $5.33 – $64.36 | 72,420 | 35 |
| Yadkinville, NC | $64.67 | $26.90 – $81.82 | 72,533 | 27 |
| Palisades Park, NJ | $47.77 | $0.00 – $191.35 | 72,549 | 11 |
| Payette, ID | $43.66 | $1.32 – $79.70 | 72,602 | 15 |
| Daphne, AL | $65.81 | $0.00 – $747.82 | 72,629 | 43 |
| Kentwood, MI | $71.54 | $26.75 – $75.50 | 72,643 | 6 |
| Clemson, SC | $62.21 | $18.10 – $135.41 | 72,659 | 47 |
| Crofton, MD | $86.80 | $0.00 – $187.59 | 72,709 | 33 |
| Altus, OK | $124.28 | $8.53 – $229.21 | 72,770 | 51 |
| Del Rio, TX | $36.71 | $0.00 – $405.37 | 72,778 | 35 |
| Ontario, OR | $26.23 | $0.00 – $97.48 | 72,862 | 64 |
| Maxwelton, WV | $47.53 | $0.00 – $57.68 | 72,865 | 7 |
| Green Brook, NJ | $66.35 | $1.54 – $121.80 | 72,959 | 23 |
| Millersville, MD | $102.79 | $0.00 – $170.96 | 72,966 | 34 |
| Kaufman, TX | $40.98 | $0.00 – $73.56 | 72,990 | 15 |
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.