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 |
|---|---|---|---|---|
| Madison Hts, MI | $41.58 | $41.52 – $49.38 | 21,932 | 2 |
| Monaca, PA | $42.36 | $0.94 – $102.04 | 21,912 | 18 |
| Beech Grove, IN | $60.10 | $1.47 – $96.51 | 21,893 | 12 |
| Brookville, NY | $35.22 | $8.12 – $152.40 | 21,876 | 4 |
| Mount Ayr, IA | $6.12 | $0.01 – $344.04 | 21,871 | 9 |
| La Canada Flintridge, CA | $0.46 | $0.14 – $1.23 | 21,860 | 3 |
| Doylestown, PA | $46.44 | $0.00 – $123.16 | 21,859 | 50 |
| Kingstree, SC | $98.72 | $25.40 – $152.61 | 21,855 | 15 |
| Saltillo, MS | $48.37 | $0.00 – $99.46 | 21,839 | 15 |
| Walled Lake, MI | $72.81 | $45.51 – $77.98 | 21,808 | 5 |
| Hutchinson, MN | $62.16 | $23.64 – $202.23 | 21,805 | 37 |
| Belchertown, MA | $51.67 | $27.31 – $60.76 | 21,793 | 11 |
| Bridgeport, TX | $38.20 | $31.61 – $55.28 | 21,790 | 6 |
| Lakeway, TX | $20.03 | $1.75 – $95.24 | 21,789 | 16 |
| Spruce Pine, NC | $48.90 | $0.00 – $73.37 | 21,746 | 20 |
| Daniels, WV | $15.87 | $0.00 – $70.87 | 21,745 | 12 |
| Alexandria Bay, NY | $112.33 | $33.73 – $236.42 | 21,741 | 9 |
| Andrews, TX | $33.27 | $2.67 – $47.55 | 21,716 | 6 |
| Edwards, CO | $148.85 | $0.00 – $238.32 | 21,698 | 26 |
| Thorndale, PA | $37.70 | $1.38 – $62.30 | 21,638 | 13 |
| Uniondale, NY | $77.78 | $0.28 – $141.03 | 21,637 | 18 |
| Gold River, CA | $11.04 | $0.00 – $50.89 | 21,634 | 5 |
| Monterey, TN | $29.16 | $5.15 – $43.19 | 21,621 | 10 |
| Gold Canyon, AZ | $77.74 | $0.00 – $101.36 | 21,607 | 8 |
| Sterling, MI | $14.65 | $12.51 – $76.94 | 21,598 | 2 |
| Jackson, LA | $37.55 | $18.06 – $62.65 | 21,576 | 5 |
| Grand Coulee, WA | $62.74 | $48.95 – $88.02 | 21,571 | 14 |
| Madison, SD | $28.81 | $27.78 – $122.65 | 21,565 | 3 |
| Riverwoods, IL | $58.38 | $58.11 – $72.51 | 21,557 | 3 |
| East Grand Forks, MN | $73.54 | $43.27 – $119.25 | 21,546 | 21 |
| Crawfordville, FL | $50.63 | $17.68 – $82.16 | 21,544 | 17 |
| Clayton, NJ | $50.11 | $3.92 – $74.94 | 21,514 | 6 |
| Cayce, SC | $75.01 | $40.47 – $300.00 | 21,508 | 15 |
| Montross, VA | $55.76 | $36.10 – $66.38 | 21,483 | 5 |
| Roscommon, MI | $15.93 | $9.13 – $43.05 | 21,472 | 3 |
| Roselle Park, NJ | $53.40 | $0.00 – $85.38 | 21,468 | 18 |
| Independence, IA | $16.87 | $0.48 – $65.35 | 21,468 | 15 |
| Belcourt, ND | $183.59 | $0.21 – $641.96 | 21,457 | 20 |
| Jeanerette, LA | $10.89 | $0.00 – $47.31 | 21,440 | 4 |
| Oak Ridge, NC | $73.92 | $34.23 – $83.44 | 21,436 | 10 |
| Sebring, OH | $32.98 | $24.90 – $55.01 | 21,424 | 5 |
| Troy, TN | $39.03 | $39.03 – $39.03 | 21,420 | 1 |
| Pompton Lakes, NJ | $61.29 | $4.12 – $73.84 | 21,390 | 4 |
| Blanding, UT | $194.06 | $0.00 – $612.97 | 21,364 | 11 |
| Magnolia Springs, AL | $70.84 | $63.91 – $77.59 | 21,355 | 4 |
| Mount Gilead, OH | $42.47 | $9.14 – $74.92 | 21,330 | 17 |
| Bremen, IN | $56.79 | $39.94 – $77.78 | 21,323 | 15 |
| North Logan, UT | $68.73 | $1.93 – $611.13 | 21,318 | 23 |
| Crestline, OH | $53.57 | $21.70 – $64.08 | 21,302 | 7 |
| Warrington, PA | $44.30 | $16.95 – $66.34 | 21,299 | 12 |
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.