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 |
|---|---|---|---|---|
| Richton Park, IL | $53.20 | $41.33 – $315.77 | 23,668 | 7 |
| Southport, NC | $41.55 | $13.09 – $71.15 | 23,650 | 22 |
| Clint, TX | $39.21 | $39.21 – $39.21 | 23,645 | 1 |
| Carmel, CA | $25.79 | $0.00 – $121.78 | 23,638 | 18 |
| Sheridan, MI | $24.59 | $7.08 – $48.17 | 23,624 | 4 |
| Ridgefield Park, NJ | $64.34 | $31.20 – $78.65 | 23,603 | 7 |
| Yarmouth, ME | $38.44 | $0.00 – $131.50 | 23,602 | 28 |
| Medical Lake, WA | $69.00 | $37.95 – $209.60 | 23,600 | 9 |
| Middletown, CA | $13.68 | $0.99 – $15.27 | 23,597 | 3 |
| N Ridgeville, OH | $43.04 | $37.71 – $47.88 | 23,579 | 6 |
| Eldon, MO | $53.84 | $7.10 – $93.59 | 23,569 | 18 |
| Bell, FL | $33.44 | $18.82 – $38.73 | 23,566 | 9 |
| New Madrid, MO | $70.77 | $15.83 – $102.70 | 23,562 | 5 |
| Dry Prong, LA | $32.81 | $0.00 – $42.41 | 23,558 | 6 |
| Lee, MA | $54.05 | $19.17 – $67.07 | 23,556 | 11 |
| Verona, VA | $63.29 | $48.45 – $78.63 | 23,546 | 11 |
| Tipton, IN | $64.85 | $24.08 – $102.70 | 23,544 | 18 |
| Smithland, KY | $32.51 | $12.17 – $39.21 | 23,540 | 5 |
| Carrollton, VA | $55.43 | $42.11 – $82.49 | 23,524 | 20 |
| Hueytown, AL | $80.92 | $0.00 – $94.04 | 23,517 | 5 |
| Adairsville, GA | $60.18 | $21.11 – $91.88 | 23,500 | 11 |
| Shamokin, PA | $11.12 | $0.00 – $38.31 | 23,495 | 15 |
| Monte Vista, CO | $159.30 | $34.39 – $228.01 | 23,489 | 10 |
| Shiner, TX | $39.26 | $39.26 – $39.26 | 23,481 | 1 |
| Newmarket, NH | $8.46 | $0.00 – $62.14 | 23,479 | 22 |
| Parsons, WV | $20.46 | $0.00 – $297.78 | 23,467 | 5 |
| Cottonwood, ID | $29.62 | $7.60 – $54.68 | 23,444 | 16 |
| Lagrange, KY | $35.72 | $27.80 – $43.53 | 23,426 | 5 |
| Chester, MD | $79.44 | $0.00 – $115.43 | 23,410 | 19 |
| Emmett, ID | $32.89 | $0.00 – $87.26 | 23,388 | 28 |
| Fort Liberty, NC | $59.26 | $14.92 – $74.66 | 23,388 | 20 |
| Coldwater, OH | $57.79 | $14.12 – $90.07 | 23,388 | 17 |
| Hidden Valley Lake, CA | $1.82 | $1.63 – $14.35 | 23,386 | 3 |
| Boardman, OR | $24.11 | $16.59 – $50.74 | 23,384 | 11 |
| Ajo, AZ | $9.61 | $0.07 – $39.74 | 23,363 | 5 |
| Stephenville, TX | $34.54 | $12.75 – $84.04 | 23,363 | 27 |
| Elizabethtown, PA | $49.36 | $0.00 – $78.32 | 23,343 | 37 |
| Hunt Valley, MD | $63.41 | $2.59 – $268.13 | 23,343 | 28 |
| Emmetsburg, IA | $4.53 | $0.00 – $101.98 | 23,342 | 9 |
| Mount Vernon, IA | $35.78 | $26.70 – $39.86 | 23,329 | 9 |
| Fairmont, NC | $39.76 | $27.93 – $55.50 | 23,326 | 6 |
| Lakeland, TN | $40.95 | $20.15 – $61.04 | 23,304 | 10 |
| Somerset, MA | $42.94 | $18.35 – $56.47 | 23,297 | 9 |
| Cameron, NC | $64.88 | $48.67 – $68.88 | 23,293 | 9 |
| Broadway, VA | $50.38 | $40.02 – $76.07 | 23,274 | 13 |
| Chatham, LA | $0.16 | $0.00 – $0.52 | 23,266 | 3 |
| Mount Olive, NC | $35.39 | $2.45 – $71.84 | 23,264 | 12 |
| Lahaina, HI | $82.11 | $19.11 – $281.20 | 23,261 | 20 |
| Grand Terrace, CA | $23.23 | $0.00 – $585.73 | 23,260 | 12 |
| Tabor City, NC | $32.06 | $2.65 – $54.67 | 23,256 | 7 |
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.