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 |
|---|---|---|---|---|
| Coolidge, AZ | $59.51 | $5.15 – $167.14 | 26,227 | 8 |
| Chatom, AL | $18.98 | $1.07 – $215.47 | 26,221 | 5 |
| Lake Clarke Shores, FL | $15.65 | $7.77 – $19.23 | 26,212 | 3 |
| Mayodan, NC | $62.52 | $22.79 – $107.12 | 26,209 | 9 |
| Little Falls, NY | $133.21 | $17.78 – $200.52 | 26,201 | 9 |
| Erie, CO | $65.21 | $0.00 – $197.77 | 26,197 | 28 |
| Truth Or Consequences, NM | $112.78 | $11.34 – $197.28 | 26,196 | 13 |
| Moody, AL | $51.77 | $24.51 – $80.75 | 26,193 | 12 |
| Woodsfield, OH | $29.08 | $0.87 – $51.57 | 26,187 | 9 |
| Bamberg, SC | $75.17 | $0.00 – $125.94 | 26,183 | 16 |
| Fernley, NV | $12.95 | $0.00 – $74.15 | 26,172 | 8 |
| Mifflintown, PA | $37.75 | $36.10 – $46.99 | 26,158 | 6 |
| Stevenson, AL | $28.17 | $0.00 – $34.38 | 26,154 | 5 |
| Forsyth, GA | $71.58 | $32.15 – $115.29 | 26,135 | 7 |
| Oconto, WI | $105.83 | $8.55 – $208.59 | 26,129 | 16 |
| Williamstown, NJ | $23.40 | $0.70 – $107.16 | 26,116 | 14 |
| Ferguson, MO | $76.31 | $7.49 – $203.75 | 26,115 | 12 |
| Beatrice, NE | $127.96 | $13.90 – $207.77 | 26,114 | 24 |
| Iuka, MS | $47.33 | $0.00 – $85.85 | 26,113 | 17 |
| Freeville, NY | $68.79 | $47.98 – $119.74 | 26,107 | 5 |
| Woodinville, WA | $60.85 | $34.04 – $123.67 | 26,102 | 35 |
| Tuscola, IL | $17.86 | $0.00 – $64.27 | 26,082 | 9 |
| Willowick, OH | $60.95 | $2.77 – $82.74 | 26,078 | 11 |
| Kodak, TN | $41.03 | $12.36 – $126.92 | 26,064 | 9 |
| Chino Valley, AZ | $50.20 | $0.00 – $76.66 | 26,058 | 18 |
| Noble, OK | $69.18 | $62.33 – $97.22 | 26,051 | 3 |
| Arapahoe, WY | $0.84 | $0.00 – $24.86 | 26,041 | 20 |
| Laurium, MI | $44.25 | $8.76 – $75.56 | 26,031 | 5 |
| Kentwood, LA | $7.46 | $0.00 – $75.51 | 26,025 | 7 |
| Portland, TX | $22.34 | $1.94 – $62.21 | 26,008 | 14 |
| Humboldt, IA | $5.84 | $0.00 – $75.56 | 25,995 | 12 |
| Mountain Home, TN | $45.78 | $9.68 – $106.02 | 25,990 | 14 |
| Dumont, NJ | $68.94 | $1.01 – $87.88 | 25,982 | 10 |
| Louisville, OH | $39.93 | $22.11 – $47.43 | 25,968 | 15 |
| Westbrook, CT | $34.43 | $0.01 – $81.76 | 25,962 | 20 |
| Gwinn, MI | $31.25 | $30.53 – $92.44 | 25,928 | 3 |
| Creve Coeur, MO | $52.26 | $10.47 – $105.50 | 25,914 | 42 |
| Pisgah, AL | $3.89 | $1.52 – $5.94 | 25,909 | 2 |
| Kew Gardens Hills, NY | $70.10 | $59.83 – $78.50 | 25,909 | 4 |
| Melvindale, MI | $59.27 | $59.24 – $61.61 | 25,901 | 2 |
| Sturbridge, MA | $37.19 | $4.39 – $86.16 | 25,895 | 19 |
| Minooka, IL | $52.18 | $20.56 – $301.81 | 25,893 | 4 |
| Boerne, TX | $49.51 | $0.00 – $97.95 | 25,880 | 35 |
| Boone, IA | $37.56 | $21.46 – $51.13 | 25,864 | 15 |
| Union, MS | $44.64 | $5.87 – $139.61 | 25,863 | 10 |
| Bennetsville, SC | $177.11 | $76.23 – $186.27 | 25,857 | 2 |
| Midlothian, TX | $51.58 | $22.30 – $352.84 | 25,845 | 15 |
| Newaygo, MI | $13.56 | $5.59 – $76.58 | 25,811 | 3 |
| Tarpon Springs, FL | $50.48 | $0.09 – $93.36 | 25,799 | 20 |
| Columbus, WI | $142.29 | $12.89 – $192.62 | 25,794 | 18 |
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.