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 |
|---|---|---|---|---|
| Southgate, KY | $41.05 | $19.76 – $114.65 | 28,853 | 10 |
| Rincon, PR | $0.89 | $0.00 – $6.16 | 28,844 | 10 |
| Dallas, NC | $55.02 | $12.26 – $64.87 | 28,836 | 17 |
| Vermilion, OH | $46.65 | $2.88 – $676.34 | 28,816 | 18 |
| Keystone Heights, FL | $44.67 | $1.02 – $83.54 | 28,761 | 13 |
| Westmont, IL | $57.57 | $0.00 – $163.67 | 28,754 | 43 |
| Waupun, WI | $91.15 | $18.86 – $133.06 | 28,715 | 20 |
| Walnut, CA | $25.46 | $3.32 – $109.14 | 28,692 | 9 |
| Warsaw, KY | $31.25 | $8.95 – $45.32 | 28,682 | 10 |
| Lucerne, CA | $21.82 | $0.32 – $799.56 | 28,635 | 7 |
| Maurice, LA | $26.85 | $0.23 – $72.54 | 28,627 | 5 |
| Wagner, SD | $275.63 | $19.60 – $456.34 | 28,596 | 7 |
| Hackleburg, AL | $1.51 | $0.00 – $1.53 | 28,595 | 3 |
| Sioux Center, IA | $21.73 | $0.00 – $102.57 | 28,588 | 23 |
| Walden, NY | $80.74 | $26.26 – $123.69 | 28,585 | 10 |
| Vieques, PR | $0.26 | $0.15 – $0.28 | 28,568 | 2 |
| Murrysville, PA | $45.02 | $27.62 – $162.28 | 28,563 | 22 |
| Epping, NH | $37.77 | $1.53 – $143.29 | 28,559 | 25 |
| Saint Amant, LA | $50.34 | $38.95 – $82.20 | 28,557 | 5 |
| Essex Junction, VT | $48.42 | $0.00 – $104.03 | 28,553 | 16 |
| Pana, IL | $7.02 | $0.04 – $51.47 | 28,550 | 8 |
| Johns Island, SC | $62.60 | $24.79 – $85.11 | 28,510 | 20 |
| Rantoul, IL | $57.00 | $44.92 – $106.12 | 28,489 | 8 |
| Ladera Ranch, CA | $26.58 | $0.31 – $98.64 | 28,443 | 18 |
| Lake Arrowhead, CA | $44.52 | $0.00 – $89.23 | 28,438 | 11 |
| Blue Earth, MN | $39.03 | $29.38 – $116.51 | 28,420 | 18 |
| Ojai, CA | $30.55 | $0.13 – $95.14 | 28,414 | 18 |
| Nome, AK | $152.64 | $0.00 – $917.53 | 28,408 | 27 |
| Wisner, LA | $0.15 | $0.00 – $0.86 | 28,405 | 5 |
| Richfield Springs, NY | $76.17 | $54.44 – $76.25 | 28,400 | 2 |
| Rockingham, VA | $59.55 | $7.89 – $640.79 | 28,390 | 48 |
| Hickman, KY | $22.04 | $15.16 – $36.98 | 28,374 | 7 |
| Delphos, OH | $45.03 | $21.70 – $64.70 | 28,373 | 12 |
| Nelsonville, OH | $33.60 | $0.04 – $122.27 | 28,334 | 14 |
| Fairview Heights, IL | $58.06 | $27.96 – $97.54 | 28,329 | 15 |
| Holdrege, NE | $69.46 | $10.67 – $202.10 | 28,267 | 22 |
| Jefferson, OH | $44.33 | $30.66 – $52.78 | 28,247 | 6 |
| Ridley Park, PA | $47.23 | $1.10 – $104.60 | 28,243 | 21 |
| Siletz, OR | $95.23 | $17.78 – $474.39 | 28,234 | 10 |
| Roanoke, AL | $39.01 | $0.00 – $225.30 | 28,233 | 13 |
| Mountain Lakes, NJ | $51.59 | $7.59 – $97.95 | 28,226 | 17 |
| Baldwinsville, NY | $44.76 | $12.05 – $103.84 | 28,221 | 18 |
| Nixa, MO | $68.04 | $15.04 – $131.56 | 28,205 | 24 |
| Bellingham, MA | $83.98 | $44.66 – $102.18 | 28,203 | 11 |
| Trafalgar, IN | $57.55 | $39.44 – $84.25 | 28,202 | 10 |
| Ewing, VA | $48.71 | $39.88 – $50.25 | 28,192 | 2 |
| East Moriches, NY | $56.73 | $4.03 – $98.12 | 28,190 | 11 |
| Cuba, NY | $83.33 | $43.86 – $151.41 | 28,170 | 12 |
| Yorktown, VA | $55.32 | $4.51 – $75.84 | 28,156 | 20 |
| Lackey, KY | $35.10 | $32.86 – $44.00 | 28,149 | 4 |
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.