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 |
|---|---|---|---|---|
| Altoona, WI | $31.75 | $6.38 – $67.79 | 27,378 | 32 |
| Portland, CT | $39.53 | $7.39 – $95.53 | 27,357 | 12 |
| Phoenix, MD | $59.56 | $56.40 – $113.62 | 27,347 | 9 |
| Greencastle, PA | $39.05 | $0.00 – $88.49 | 27,345 | 22 |
| Forest Hill, MD | $91.69 | $18.41 – $132.66 | 27,335 | 21 |
| Beaver Falls, PA | $24.74 | $0.00 – $81.06 | 27,334 | 44 |
| Johnstown, NY | $54.94 | $12.31 – $183.06 | 27,324 | 25 |
| Winooski, VT | $10.22 | $0.00 – $85.84 | 27,295 | 14 |
| Trenton, MO | $49.65 | $0.00 – $89.96 | 27,288 | 15 |
| Coatesville, PA | $44.72 | $0.02 – $734.65 | 27,288 | 30 |
| Shaw, MS | $46.27 | $5.44 – $162.00 | 27,282 | 7 |
| Morganfield, KY | $34.64 | $6.09 – $61.49 | 27,280 | 14 |
| East Windsor, NJ | $50.71 | $0.00 – $137.95 | 27,266 | 23 |
| Benicia, CA | $29.87 | $0.00 – $249.08 | 27,256 | 7 |
| Saint Anthony, ID | $16.96 | $0.00 – $119.31 | 27,192 | 12 |
| Iron River, MI | $35.20 | $0.00 – $49.55 | 27,173 | 7 |
| Barlow, KY | $24.38 | $0.00 – $35.95 | 27,168 | 6 |
| Kahuku, HI | $168.27 | $26.03 – $784.25 | 27,157 | 15 |
| Mc Cook, NE | $58.51 | $42.11 – $88.08 | 27,136 | 21 |
| Milton, WA | $61.37 | $53.50 – $80.74 | 27,124 | 7 |
| Windsor, VT | $19.38 | $0.00 – $65.72 | 27,086 | 23 |
| Endicott, NY | $60.16 | $5.13 – $83.44 | 27,083 | 27 |
| Coquille, OR | $33.66 | $0.68 – $163.40 | 27,081 | 19 |
| Homer, NY | $85.96 | $43.62 – $102.65 | 27,067 | 7 |
| Fircrest, WA | $69.49 | $55.14 – $427.00 | 27,045 | 9 |
| Pittsboro, NC | $54.01 | $21.73 – $121.03 | 27,019 | 30 |
| Jacksonville, TX | $33.10 | $3.47 – $90.19 | 27,011 | 23 |
| Purchase, NY | $77.97 | $0.00 – $378.89 | 27,005 | 39 |
| Ripon, WI | $74.73 | $13.30 – $137.70 | 27,004 | 22 |
| Leesville, SC | $58.00 | $26.96 – $59.52 | 26,997 | 2 |
| Mount Pocono, PA | $36.45 | $19.67 – $82.20 | 26,995 | 9 |
| Corydon, IA | $3.35 | $0.00 – $48.10 | 26,982 | 15 |
| Dardanelle, AR | $37.03 | $5.77 – $43.42 | 26,966 | 16 |
| Sutherlin, OR | $64.59 | $48.09 – $86.33 | 26,951 | 10 |
| Kenansville, NC | $50.60 | $0.00 – $68.44 | 26,942 | 20 |
| Lancaster, NH | $107.53 | $4.11 – $541.99 | 26,930 | 20 |
| Fountain Hill, PA | $50.56 | $0.00 – $151.55 | 26,928 | 57 |
| Upper Darby, PA | $30.81 | $0.00 – $68.24 | 26,917 | 21 |
| Cleveland, OK | $165.27 | $128.81 – $198.51 | 26,893 | 8 |
| Jonesville, NC | $45.36 | $25.61 – $60.18 | 26,889 | 14 |
| Peapack, NJ | $32.02 | $32.02 – $32.02 | 26,885 | 1 |
| Mc Farland, CA | $66.85 | $26.68 – $134.89 | 26,857 | 6 |
| Semmes, AL | $49.40 | $0.00 – $101.03 | 26,850 | 13 |
| Fort Drum, NY | $67.45 | $36.24 – $440.10 | 26,834 | 21 |
| Hillsboro, IL | $1.53 | $0.00 – $59.62 | 26,821 | 12 |
| Kaplan, LA | $38.04 | $26.28 – $55.34 | 26,784 | 7 |
| Pratt, KS | $71.48 | $3.88 – $119.48 | 26,758 | 24 |
| Peachtree Corners, GA | $60.39 | $2.70 – $71.74 | 26,757 | 10 |
| Marlboro, MA | $60.83 | $33.30 – $67.21 | 26,736 | 6 |
| Silvis, IL | $51.91 | $10.38 – $79.55 | 26,735 | 19 |
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.