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 |
|---|---|---|---|---|
| Paradise Valley, AZ | $52.40 | $10.66 – $77.97 | 21,287 | 10 |
| Coeburn, VA | $53.41 | $25.34 – $79.52 | 21,274 | 10 |
| Pickens, SC | $63.75 | $21.85 – $74.26 | 21,267 | 7 |
| Glen Daniel, WV | $45.18 | $0.00 – $70.69 | 21,267 | 6 |
| Nags Head, NC | $43.03 | $0.00 – $68.03 | 21,259 | 19 |
| Hanover, MD | $96.83 | $18.44 – $191.86 | 21,243 | 30 |
| Beardstown, IL | $4.93 | $0.00 – $49.86 | 21,242 | 5 |
| Morrison, TN | $34.60 | $10.84 – $53.39 | 21,229 | 7 |
| Elmendorf Afb, AK | $89.32 | $84.85 – $89.44 | 21,218 | 2 |
| Bladensburg, MD | $85.61 | $39.96 – $111.26 | 21,218 | 7 |
| Charles City, VA | $54.85 | $27.44 – $71.45 | 21,217 | 6 |
| Oregon, IL | $46.70 | $15.64 – $275.77 | 21,214 | 7 |
| Ord, NE | $53.96 | $0.00 – $111.27 | 21,213 | 14 |
| East Ridge, TN | $52.14 | $1.91 – $60.34 | 21,205 | 8 |
| Westhampton Beach, NY | $138.30 | $44.44 – $142.93 | 21,197 | 9 |
| Salem, WV | $47.12 | $33.02 – $70.36 | 21,197 | 9 |
| Albuquergue, NM | $76.45 | $76.45 – $76.45 | 21,187 | 1 |
| Eddyville, KY | $30.57 | $27.45 – $40.24 | 21,182 | 9 |
| Clearfield, PA | $33.48 | $0.00 – $96.48 | 21,178 | 22 |
| Mattawa, WA | $48.64 | $14.55 – $80.53 | 21,159 | 13 |
| Dawes, WV | $7.95 | $0.00 – $12.18 | 21,148 | 5 |
| Harrison, MI | $25.80 | $25.79 – $30.39 | 21,137 | 2 |
| Osceola, AR | $35.98 | $22.86 – $57.07 | 21,112 | 8 |
| Olivia, MN | $123.37 | $0.00 – $245.30 | 21,109 | 15 |
| Taylors, SC | $64.55 | $39.72 – $79.62 | 21,106 | 11 |
| Chester, CA | $36.89 | $0.84 – $66.71 | 21,077 | 5 |
| Maineville, OH | $66.99 | $21.26 – $485.48 | 21,059 | 19 |
| Albion, IL | $0.49 | $0.00 – $34.08 | 21,042 | 3 |
| Davenport, WA | $52.22 | $28.72 – $76.92 | 21,037 | 10 |
| Mission, KS | $18.85 | $0.00 – $53.52 | 21,031 | 10 |
| Mashpee, MA | $51.91 | $0.00 – $187.62 | 21,031 | 31 |
| Barnegat, NJ | $29.75 | $23.47 – $62.55 | 21,025 | 9 |
| Sussex, WI | $36.25 | $0.00 – $48.93 | 21,023 | 17 |
| Scotts Hill, TN | $41.44 | $20.52 – $49.53 | 21,021 | 7 |
| Middletown, MD | $103.07 | $0.00 – $124.61 | 20,990 | 8 |
| Warren, AR | $31.49 | $0.00 – $44.41 | 20,976 | 17 |
| El Rito, NM | $18.79 | $7.47 – $120.30 | 20,957 | 4 |
| Wiinnsboro, LA | $0.00 | $0.00 – $0.00 | 20,941 | 1 |
| Hayesville, NC | $43.59 | $0.00 – $165.70 | 20,932 | 10 |
| Moneta, VA | $61.07 | $29.13 – $69.53 | 20,928 | 12 |
| Autaugaville, AL | $83.88 | $0.00 – $85.35 | 20,922 | 3 |
| Harrisville, WV | $12.60 | $0.01 – $65.06 | 20,922 | 8 |
| York, ME | $38.37 | $10.01 – $63.30 | 20,911 | 47 |
| Fort Belvoir, VA | $67.69 | $7.55 – $614.93 | 20,910 | 26 |
| Milford, NH | $34.31 | $0.00 – $71.94 | 20,901 | 27 |
| Dodgeville, WI | $77.64 | $7.50 – $132.90 | 20,893 | 25 |
| Newport, NH | $108.85 | $92.40 – $196.53 | 20,867 | 6 |
| Columbia, PA | $51.44 | $5.66 – $113.82 | 20,852 | 11 |
| Brunswick, OH | $39.06 | $18.05 – $103.50 | 20,847 | 32 |
| Ottawa, OH | $40.61 | $15.71 – $82.72 | 20,833 | 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.