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 |
|---|---|---|---|---|
| Lansdowne, VA | $60.23 | $12.66 – $128.89 | 22,337 | 29 |
| Monroe, NJ | $59.16 | $1.81 – $160.12 | 22,336 | 9 |
| Bernalillo, NM | $107.96 | $5.42 – $118.74 | 22,333 | 9 |
| Bardonia, NY | $93.69 | $13.42 – $129.15 | 22,330 | 8 |
| Friday Harbor, WA | $31.52 | $2.86 – $74.37 | 22,327 | 15 |
| Dunedin, FL | $42.03 | $1.39 – $316.67 | 22,322 | 23 |
| Preston, ID | $15.51 | $0.00 – $66.73 | 22,320 | 11 |
| Susquehanna, PA | $23.85 | $0.00 – $78.50 | 22,307 | 11 |
| Sausalito, CA | $7.38 | $0.00 – $45.62 | 22,304 | 10 |
| Studio City, CA | $25.35 | $0.00 – $130.91 | 22,295 | 14 |
| Sodus, NY | $66.80 | $19.48 – $81.13 | 22,291 | 7 |
| Aitkin, MN | $115.32 | $16.85 – $261.90 | 22,269 | 23 |
| Pittburgh, PA | $44.54 | $44.54 – $44.54 | 22,264 | 1 |
| Lineville, AL | $71.94 | $44.40 – $227.49 | 22,254 | 5 |
| Belgrade, MT | $85.02 | $0.13 – $142.02 | 22,239 | 18 |
| Swanton, VT | $52.27 | $0.45 – $104.25 | 22,231 | 8 |
| Lady Lake, FL | $30.64 | $0.76 – $108.60 | 22,216 | 25 |
| Summit, MS | $56.60 | $14.58 – $78.16 | 22,203 | 8 |
| Peyton, CO | $117.06 | $11.64 – $207.59 | 22,199 | 11 |
| Stanley, WI | $104.14 | $10.41 – $219.55 | 22,198 | 9 |
| Pennsdale, PA | $0.28 | $0.28 – $0.28 | 22,176 | 1 |
| Elmsford, NY | $94.83 | $32.28 – $146.41 | 22,164 | 11 |
| Pewaukee, WI | $21.80 | $0.00 – $47.81 | 22,160 | 29 |
| Robbinsdale, MN | $73.25 | $16.61 – $311.85 | 22,150 | 61 |
| Baldwinville, MA | $64.28 | $1.52 – $78.00 | 22,143 | 8 |
| N Miami Beach, FL | $31.23 | $0.00 – $78.61 | 22,128 | 7 |
| Lakeview, MI | $8.41 | $7.29 – $56.87 | 22,111 | 4 |
| Seminary, MS | $44.85 | $26.40 – $61.62 | 22,110 | 7 |
| Perry Hall, MD | $101.27 | $21.01 – $122.31 | 22,109 | 11 |
| Canonsburg, PA | $46.56 | $20.38 – $98.80 | 22,105 | 19 |
| Suitland, MD | $97.77 | $55.53 – $158.59 | 22,102 | 25 |
| Dyer, TN | $35.04 | $7.62 – $44.74 | 22,094 | 8 |
| Ford Heights, IL | $27.96 | $2.20 – $62.74 | 22,091 | 6 |
| Yorkville, IL | $52.53 | $11.87 – $69.47 | 22,083 | 21 |
| Ashland, MS | $58.85 | $19.55 – $107.88 | 22,074 | 6 |
| Clayton, GA | $55.78 | $0.00 – $129.71 | 22,072 | 14 |
| Mobridge, SD | $95.89 | $35.66 – $96.41 | 22,062 | 3 |
| Brooklyn, MD | $110.05 | $2.64 – $215.29 | 22,053 | 8 |
| Beebe, AR | $32.78 | $0.58 – $45.34 | 22,044 | 8 |
| Brookhaven, GA | $72.10 | $10.98 – $98.19 | 22,033 | 17 |
| Clendenin, WV | $10.99 | $0.00 – $14.30 | 22,015 | 4 |
| Oneill, NE | $69.91 | $10.13 – $136.33 | 22,010 | 17 |
| Scott Afb, IL | $46.82 | $46.74 – $75.34 | 22,008 | 2 |
| Kennett Square, PA | $43.52 | $0.00 – $71.25 | 22,007 | 33 |
| Weed, CA | $1.74 | $1.01 – $7.23 | 22,003 | 7 |
| Harvard, IL | $32.48 | $0.00 – $65.66 | 21,963 | 7 |
| Staunton, IL | $1.48 | $0.00 – $322.05 | 21,961 | 5 |
| Atoka, OK | $147.92 | $0.04 – $642.89 | 21,948 | 13 |
| Corry, PA | $7.57 | $0.00 – $42.26 | 21,945 | 15 |
| Woodstock, GA | $36.33 | $18.58 – $166.62 | 21,944 | 16 |
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.