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 |
|---|---|---|---|---|
| Beresford, SD | $91.53 | $91.53 – $91.53 | 1,964 | 1 |
| Smithfield, UT | $55.20 | $36.47 – $58.59 | 1,964 | 3 |
| Westwood, CA | $2.69 | $0.81 – $3.21 | 1,964 | 2 |
| Waterloo, NE | $13.47 | $4.54 – $52.90 | 1,965 | 2 |
| Ft Pierce, FL | $5.70 | $0.42 – $8.39 | 1,965 | 3 |
| Pioneer, LA | $3.81 | $3.81 – $3.81 | 1,965 | 1 |
| Ave Maria, FL | $27.64 | $25.33 – $42.14 | 1,965 | 4 |
| Mt Olive, NC | $25.70 | $4.91 – $54.96 | 1,967 | 2 |
| Orleans, CA | $0.01 | $0.01 – $0.01 | 1,967 | 1 |
| Esopus, NY | $55.84 | $55.84 – $55.84 | 1,967 | 1 |
| Madrid, NY | $53.85 | $0.00 – $55.72 | 1,967 | 2 |
| Au Gres, MI | $16.83 | $16.83 – $16.83 | 1,968 | 1 |
| Princeton, NC | $42.69 | $42.52 – $45.81 | 1,968 | 3 |
| Becker, MN | $57.70 | $54.03 – $75.16 | 1,969 | 5 |
| Richfield, OH | $30.07 | $15.25 – $85.50 | 1,969 | 4 |
| Emmitsburg, MD | $81.98 | $27.76 – $136.72 | 1,969 | 7 |
| Kent, CT | $57.96 | $0.32 – $66.02 | 1,970 | 4 |
| Silverton, CO | $17.16 | $17.16 – $17.16 | 1,970 | 1 |
| Eldred, PA | $8.41 | $0.39 – $19.69 | 1,970 | 2 |
| Lanai City, HI | $260.24 | $0.00 – $333.62 | 1,972 | 4 |
| Kalida, OH | $33.94 | $26.91 – $36.66 | 1,973 | 4 |
| Galesville, WI | $38.91 | $14.92 – $41.99 | 1,974 | 3 |
| Erie, IL | $50.67 | $50.67 – $50.67 | 1,976 | 1 |
| Hinsdale, MT | $118.33 | $118.33 – $118.33 | 1,977 | 1 |
| Brock, TX | $60.35 | $60.35 – $60.35 | 1,978 | 1 |
| Pillager, MN | $71.59 | $40.99 – $185.32 | 1,979 | 5 |
| Waterloo, WI | $35.32 | $26.00 – $35.99 | 1,979 | 2 |
| Pima, AZ | $42.56 | $42.56 – $42.56 | 1,982 | 1 |
| Lacrosse, KS | $119.37 | $119.37 – $119.37 | 1,985 | 1 |
| Hudson, CO | $221.56 | $221.56 – $221.56 | 1,986 | 1 |
| Bow, NH | $50.47 | $6.82 – $52.03 | 1,986 | 3 |
| To0A Baja, PR | $0.10 | $0.10 – $0.10 | 1,987 | 1 |
| Bloomfield, KY | $33.47 | $29.16 – $34.53 | 1,988 | 3 |
| Pierce City, MO | $1.77 | $0.00 – $1.97 | 1,989 | 2 |
| Roanoke, TX | $47.74 | $29.91 – $51.52 | 1,990 | 2 |
| Minco, OK | $102.38 | $102.38 – $102.38 | 1,992 | 1 |
| Carnation, WA | $44.55 | $44.55 – $44.55 | 1,993 | 1 |
| Jamestown, RI | $37.26 | $34.32 – $76.61 | 1,993 | 3 |
| Pepperell, MA | $55.65 | $7.44 – $91.29 | 1,995 | 7 |
| Grantsville, UT | $67.31 | $52.09 – $159.88 | 1,997 | 5 |
| Union Grove, WI | $29.00 | $21.37 – $43.47 | 1,998 | 7 |
| Oak Hill, VA | $133.01 | $133.01 – $133.01 | 2,000 | 1 |
| Titusville, NJ | $42.29 | $42.29 – $42.29 | 2,003 | 1 |
| Sidney, IA | $0.44 | $0.30 – $11.64 | 2,003 | 2 |
| Conemaugh, PA | $49.42 | $49.42 – $49.42 | 2,004 | 1 |
| Brodhead, KY | $38.57 | $24.05 – $39.40 | 2,005 | 2 |
| Bald Knob, AR | $15.17 | $0.00 – $24.75 | 2,007 | 6 |
| Halifax, MA | $99.26 | $50.62 – $99.55 | 2,015 | 2 |
| Ellinwood, KS | $223.89 | $85.97 – $225.91 | 2,015 | 2 |
| Johnson, AR | $36.14 | $36.14 – $36.14 | 2,016 | 1 |
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.