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 |
|---|---|---|---|---|
| River Edge, NJ | $55.01 | $25.50 – $111.84 | 22,838 | 7 |
| Eau Claire, MI | $2.16 | $2.16 – $2.16 | 22,827 | 1 |
| Antlers, OK | $121.47 | $1.89 – $644.70 | 22,820 | 10 |
| Cloquet, MN | $157.03 | $8.54 – $719.00 | 22,819 | 56 |
| Ra;Eigh, NC | $72.21 | $72.21 – $72.21 | 22,819 | 1 |
| Bushnell, FL | $33.63 | $0.00 – $156.67 | 22,797 | 13 |
| Saint Ignace, MI | $43.70 | $14.10 – $82.37 | 22,796 | 5 |
| Mcloud, OK | $391.13 | $84.42 – $648.93 | 22,786 | 11 |
| Columbus, NC | $32.27 | $1.27 – $59.09 | 22,785 | 20 |
| Montgomery Village, MD | $82.52 | $53.68 – $130.85 | 22,782 | 11 |
| Bruceton, TN | $34.33 | $29.63 – $34.63 | 22,781 | 2 |
| Southport, CT | $56.06 | $0.00 – $88.66 | 22,765 | 10 |
| Dacula, GA | $65.56 | $4.58 – $120.59 | 22,761 | 20 |
| Evansdale, IA | $39.67 | $26.85 – $44.99 | 22,758 | 9 |
| Lisle, IL | $58.88 | $13.41 – $263.54 | 22,747 | 35 |
| Scotia, CA | $0.70 | $0.70 – $0.70 | 22,744 | 1 |
| Redwood Valley, CA | $0.03 | $0.00 – $2.77 | 22,730 | 2 |
| Grandville, MI | $60.76 | $41.64 – $78.34 | 22,713 | 10 |
| Lake Ariel, PA | $21.26 | $0.00 – $490.30 | 22,706 | 7 |
| Riverdale, GA | $67.80 | $12.41 – $135.26 | 22,699 | 29 |
| Newfane, NY | $38.28 | $4.93 – $56.39 | 22,683 | 7 |
| Hilton Head, SC | $88.64 | $25.61 – $238.70 | 22,646 | 17 |
| Brenham, TX | $42.99 | $0.00 – $77.34 | 22,642 | 36 |
| Mt Pleasant, PA | $40.87 | $27.47 – $89.60 | 22,637 | 22 |
| Bethel Park, PA | $45.34 | $14.80 – $60.56 | 22,637 | 34 |
| Fraser, MI | $65.00 | $14.97 – $67.17 | 22,622 | 3 |
| Valdese, NC | $29.38 | $13.71 – $579.27 | 22,619 | 11 |
| Abbeville, AL | $37.90 | $0.00 – $219.16 | 22,603 | 7 |
| Simmesport, LA | $3.99 | $0.00 – $77.21 | 22,602 | 3 |
| Lutcher, LA | $29.16 | $12.89 – $203.21 | 22,586 | 11 |
| Port Richey, FL | $30.40 | $0.00 – $227.91 | 22,579 | 28 |
| Hermantown, MN | $72.57 | $15.23 – $132.53 | 22,568 | 22 |
| Burgaw, NC | $55.67 | $45.18 – $90.18 | 22,535 | 9 |
| Dewey, AZ | $53.51 | $37.35 – $69.82 | 22,531 | 12 |
| Rosamond, CA | $41.79 | $38.37 – $92.17 | 22,520 | 3 |
| Belhaven, NC | $50.85 | $9.69 – $72.24 | 22,520 | 10 |
| Juneau, WI | $27.82 | $10.21 – $35.98 | 22,518 | 9 |
| Gunnison, CO | $68.86 | $0.00 – $569.43 | 22,484 | 35 |
| Walsenburg, CO | $150.39 | $44.92 – $264.25 | 22,460 | 20 |
| Mohawk, NY | $69.67 | $56.79 – $74.80 | 22,453 | 2 |
| Chesapeake, WV | $58.68 | $58.68 – $58.68 | 22,448 | 1 |
| Windham, NH | $53.08 | $7.84 – $165.49 | 22,441 | 18 |
| Salem, WI | $35.53 | $22.71 – $46.38 | 22,434 | 11 |
| Woodruff, WI | $33.12 | $0.60 – $64.43 | 22,413 | 14 |
| Milton, PA | $37.66 | $17.42 – $62.68 | 22,378 | 10 |
| Lawrenceville, VA | $44.57 | $16.66 – $45.69 | 22,370 | 5 |
| Phelan, CA | $16.61 | $6.62 – $36.11 | 22,369 | 6 |
| Martin, SD | $155.81 | $81.76 – $429.26 | 22,352 | 3 |
| Barnesville, OH | $26.99 | $0.61 – $58.81 | 22,352 | 16 |
| Freeburn, KY | $31.09 | $31.02 – $31.48 | 22,343 | 2 |
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.