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 |
|---|---|---|---|---|
| South Hempstead, NY | $65.36 | $65.36 – $65.36 | 1,905 | 1 |
| Westhope, ND | $134.48 | $134.48 – $134.48 | 1,907 | 1 |
| Lovell, WY | $57.04 | $0.00 – $340.36 | 1,908 | 5 |
| Harrisburg, SD | $52.50 | $34.89 – $67.35 | 1,908 | 2 |
| Shannon, MS | $50.13 | $48.01 – $67.70 | 1,909 | 2 |
| Hopkins, MN | $142.23 | $49.55 – $257.08 | 1,910 | 6 |
| Fairview, MT | $0.13 | $0.13 – $0.13 | 1,911 | 1 |
| Newark, IL | $63.04 | $63.04 – $63.04 | 1,912 | 1 |
| Lake Luzerne, NY | $73.82 | $71.72 – $108.50 | 1,912 | 2 |
| La Habra Heights, CA | $45.43 | $44.56 – $127.62 | 1,916 | 2 |
| Verona, PA | $39.00 | $27.50 – $51.94 | 1,917 | 6 |
| Wasahington, PA | $36.02 | $36.02 – $36.02 | 1,918 | 1 |
| Faith, NC | $52.12 | $46.81 – $54.45 | 1,921 | 3 |
| Old Town, FL | $46.83 | $46.83 – $46.83 | 1,922 | 1 |
| Marlin, TX | $22.38 | $2.58 – $57.99 | 1,924 | 4 |
| Osceola, NE | $69.04 | $69.04 – $69.04 | 1,924 | 1 |
| Duncannon, PA | $59.31 | $44.95 – $79.19 | 1,926 | 4 |
| Falmouth, KY | $29.09 | $10.16 – $38.17 | 1,927 | 3 |
| Middlesex, NJ | $35.24 | $11.26 – $36.25 | 1,929 | 2 |
| Frederick, OK | $60.28 | $58.72 – $80.87 | 1,933 | 2 |
| Saint Johns, AZ | $31.14 | $1.39 – $63.62 | 1,934 | 3 |
| Homer Glen, IL | $99.43 | $23.87 – $115.00 | 1,934 | 5 |
| Whitney, TX | $46.09 | $27.40 – $62.76 | 1,935 | 4 |
| Boulder Creek, CA | $5.22 | $5.22 – $5.22 | 1,936 | 1 |
| Olivette, MO | $28.80 | $27.28 – $77.42 | 1,941 | 3 |
| Potts, PA | $47.15 | $47.15 – $47.15 | 1,942 | 1 |
| Bolivar, PA | $50.62 | $42.74 – $50.68 | 1,945 | 2 |
| Le Claire, IA | $27.85 | $8.09 – $46.33 | 1,945 | 5 |
| Smithton, IL | $47.16 | $33.28 – $51.59 | 1,948 | 2 |
| Sarah, MS | $38.70 | $10.60 – $40.99 | 1,948 | 2 |
| Elk City, KS | $27.24 | $27.24 – $27.24 | 1,948 | 1 |
| Odessa, FL | $67.46 | $27.12 – $172.58 | 1,950 | 7 |
| Hales Corners, WI | $46.69 | $35.40 – $61.08 | 1,951 | 4 |
| Harmony, NC | $56.45 | $7.55 – $62.03 | 1,951 | 4 |
| Tammpa, FL | $49.29 | $49.29 – $49.29 | 1,951 | 1 |
| Toledo, WA | $21.91 | $21.71 – $22.79 | 1,951 | 2 |
| Pelzer, SC | $62.06 | $61.95 – $69.23 | 1,953 | 2 |
| New Glarus, WI | $52.45 | $52.45 – $52.45 | 1,953 | 1 |
| Snow Camp, NC | $63.11 | $63.11 – $63.11 | 1,956 | 1 |
| Star Junction, PA | $46.62 | $46.62 – $46.62 | 1,957 | 1 |
| Hurlburt Field, FL | $97.57 | $0.00 – $514.16 | 1,957 | 6 |
| Nolanville, TX | $46.13 | $46.13 – $46.13 | 1,957 | 1 |
| Lake Junaluska, NC | $60.73 | $60.73 – $60.73 | 1,958 | 1 |
| Marco Island, FL | $56.03 | $55.24 – $61.71 | 1,959 | 2 |
| Fox River Grove, IL | $65.37 | $62.26 – $78.09 | 1,960 | 4 |
| Woodlyn, PA | $23.42 | $2.08 – $28.31 | 1,961 | 2 |
| Barksdale Afb, LA | $43.19 | $0.57 – $119.82 | 1,961 | 8 |
| Rostraver Township, PA | $28.23 | $7.16 – $130.00 | 1,962 | 13 |
| Channelview, TX | $44.10 | $13.64 – $141.85 | 1,963 | 3 |
| Nekoosa, WI | $40.10 | $28.07 – $64.19 | 1,963 | 6 |
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.