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 |
|---|---|---|---|---|
| Grandview, WA | $29.74 | $6.06 – $82.00 | 109,049 | 35 |
| Novato, CA | $14.88 | $0.00 – $347.32 | 109,082 | 59 |
| Spencer, WV | $28.27 | $0.00 – $595.49 | 109,226 | 26 |
| Chesterton, IN | $52.96 | $6.11 – $96.27 | 109,293 | 68 |
| Selmer, TN | $39.77 | $19.76 – $49.69 | 109,402 | 25 |
| Lafayette, TN | $33.06 | $2.35 – $53.00 | 109,513 | 28 |
| Sparta, TN | $35.85 | $16.03 – $64.18 | 109,534 | 31 |
| Saint Albans, VT | $31.19 | $0.00 – $134.68 | 109,585 | 70 |
| Chardon, OH | $58.49 | $6.33 – $120.31 | 109,709 | 75 |
| Crawfordsville, IN | $62.40 | $4.76 – $109.94 | 109,927 | 50 |
| Caribou, ME | $22.49 | $1.71 – $347.67 | 109,960 | 30 |
| Yazoo City, MS | $57.29 | $0.00 – $120.12 | 109,986 | 29 |
| Kingsville, TX | $25.35 | $4.89 – $46.72 | 110,001 | 23 |
| Niles, OH | $39.65 | $19.69 – $137.84 | 110,014 | 33 |
| Ammon, ID | $65.28 | $20.79 – $124.80 | 110,022 | 38 |
| New Milford, CT | $60.53 | $0.00 – $127.56 | 110,043 | 63 |
| Sparks, NV | $55.33 | $1.65 – $219.86 | 110,086 | 107 |
| Farmerville, LA | $20.00 | $0.00 – $54.50 | 110,114 | 18 |
| Ocoee, FL | $52.36 | $0.00 – $123.96 | 110,136 | 76 |
| Greenwich, CT | $59.30 | $0.00 – $164.70 | 110,186 | 114 |
| Centre, AL | $45.21 | $2.04 – $205.14 | 110,456 | 40 |
| Winnetka, CA | $6.50 | $0.34 – $70.95 | 110,560 | 10 |
| Lisbon, OH | $64.88 | $3.68 – $161.17 | 110,585 | 21 |
| Parsippany, NJ | $39.48 | $0.29 – $146.37 | 110,606 | 38 |
| Christopher, IL | $0.01 | $0.01 – $0.01 | 110,946 | 1 |
| Price, UT | $68.81 | $0.49 – $537.81 | 111,103 | 49 |
| Globe, AZ | $33.84 | $0.00 – $111.81 | 111,174 | 38 |
| Elmont, NY | $71.99 | $0.00 – $125.91 | 111,244 | 22 |
| Clarksville, AR | $33.52 | $7.52 – $46.42 | 111,392 | 23 |
| Garner, NC | $59.11 | $7.72 – $112.94 | 111,441 | 66 |
| Hurricane, WV | $33.08 | $0.00 – $73.28 | 111,492 | 60 |
| Leonardtown, MD | $88.66 | $0.00 – $252.63 | 111,530 | 95 |
| Hazel Crest, IL | $37.31 | $0.04 – $250.00 | 111,662 | 68 |
| Jasper, IN | $48.65 | $20.17 – $94.63 | 111,922 | 88 |
| Missouri City, TX | $46.41 | $0.00 – $139.29 | 112,004 | 61 |
| Prospect Park, NJ | $67.01 | $58.68 – $67.73 | 112,144 | 3 |
| Lincoln, IL | $8.93 | $0.01 – $77.04 | 112,181 | 20 |
| Aberdeen, SD | $43.35 | $0.00 – $158.49 | 112,388 | 33 |
| Van Buren, AR | $37.19 | $6.57 – $81.26 | 112,420 | 27 |
| Carthage, NY | $129.78 | $25.47 – $310.87 | 112,478 | 37 |
| Machias, ME | $8.22 | $1.27 – $69.56 | 112,776 | 11 |
| Rome, NY | $74.23 | $0.00 – $206.42 | 112,812 | 68 |
| Belleview, FL | $33.55 | $10.15 – $61.21 | 112,829 | 12 |
| Belmont, NC | $51.70 | $2.11 – $147.24 | 112,908 | 68 |
| Massena, NY | $83.77 | $0.00 – $225.34 | 113,070 | 41 |
| Glendora, CA | $46.56 | $0.00 – $618.49 | 113,089 | 96 |
| Avon, OH | $41.77 | $12.24 – $116.84 | 113,125 | 74 |
| Wakefield, RI | $52.58 | $21.49 – $105.19 | 113,230 | 96 |
| Lockport, NY | $75.48 | $6.70 – $184.22 | 113,471 | 72 |
| Glen Dale, WV | $57.39 | $0.28 – $111.71 | 113,501 | 45 |
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.