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 |
|---|---|---|---|---|
| Fulton, KY | $33.03 | $14.37 – $47.39 | 19,799 | 7 |
| Auburn, NE | $53.70 | $23.02 – $114.56 | 19,780 | 9 |
| Whitwell, TN | $42.85 | $24.36 – $58.16 | 19,745 | 5 |
| Guymon, OK | $71.90 | $30.53 – $142.99 | 19,723 | 15 |
| West Dundee, IL | $57.32 | $21.59 – $76.00 | 19,720 | 20 |
| Monticello, IN | $55.31 | $16.29 – $72.43 | 19,715 | 14 |
| East Los Angeles, CA | $12.66 | $0.00 – $93.74 | 19,664 | 10 |
| Elsmere, KY | $49.91 | $27.86 – $53.03 | 19,664 | 4 |
| Cody, WY | $51.93 | $0.00 – $83.52 | 19,650 | 30 |
| Catano, PR | $2.93 | $0.00 – $80.17 | 19,646 | 11 |
| Hartsville, TN | $30.09 | $15.03 – $53.14 | 19,640 | 10 |
| Abilene, KS | $85.02 | $7.49 – $117.78 | 19,629 | 10 |
| Federalsburg, MD | $149.05 | $81.13 – $169.63 | 19,622 | 7 |
| Hurricane, UT | $58.04 | $9.42 – $94.52 | 19,618 | 15 |
| Williams, AZ | $25.44 | $0.00 – $155.61 | 19,602 | 10 |
| Rocky Point, NC | $51.85 | $27.64 – $66.33 | 19,595 | 7 |
| Duncansville, PA | $41.71 | $1.50 – $53.00 | 19,573 | 12 |
| Cherokee, OK | $23.25 | $0.00 – $79.71 | 19,564 | 10 |
| Woodruff, SC | $72.52 | $24.60 – $137.14 | 19,532 | 6 |
| Warsaw, VA | $57.02 | $15.48 – $72.69 | 19,522 | 8 |
| Chamblee, GA | $88.19 | $9.70 – $97.55 | 19,513 | 11 |
| Sweetwater, TX | $41.54 | $22.02 – $60.45 | 19,510 | 7 |
| Shillington, PA | $50.95 | $0.00 – $96.45 | 19,506 | 5 |
| Calhoun City, MS | $55.12 | $3.71 – $115.49 | 19,494 | 13 |
| Dungannon, VA | $49.26 | $18.12 – $64.17 | 19,476 | 10 |
| Barrow, AK | $27.46 | $2.94 – $619.57 | 19,471 | 5 |
| Estacada, OR | $76.69 | $18.10 – $100.89 | 19,468 | 12 |
| Sidney, MT | $51.84 | $0.09 – $480.90 | 19,439 | 26 |
| Hartwell, GA | $81.13 | $24.40 – $114.70 | 19,424 | 9 |
| Fort Mitchell, KY | $37.64 | $27.66 – $53.45 | 19,423 | 11 |
| Kyle, SD | $433.12 | $7.32 – $449.53 | 19,406 | 3 |
| Newcomerstown, OH | $27.19 | $18.92 – $41.26 | 19,401 | 5 |
| North Manchester, IN | $61.57 | $31.02 – $85.35 | 19,398 | 12 |
| Coopers Mills, ME | $1.69 | $1.03 – $35.24 | 19,380 | 4 |
| Fort Sill, OK | $93.09 | $0.00 – $629.25 | 19,372 | 20 |
| Iron River, WI | $14.20 | $2.32 – $44.99 | 19,363 | 6 |
| Moosic, PA | $45.32 | $0.65 – $96.22 | 19,360 | 13 |
| Smyrna, DE | $49.90 | $0.00 – $97.88 | 19,352 | 22 |
| Elgin, SC | $53.77 | $27.47 – $78.31 | 19,338 | 10 |
| East Amherst, NY | $65.51 | $22.21 – $167.76 | 19,326 | 37 |
| Lily, KY | $17.06 | $16.59 – $34.37 | 19,308 | 2 |
| Hubbard, OH | $39.49 | $18.96 – $55.68 | 19,307 | 11 |
| Bassett, VA | $55.19 | $40.90 – $77.95 | 19,295 | 7 |
| Atlanta, MI | $11.12 | $11.12 – $11.12 | 19,289 | 1 |
| Rising Sun, IN | $52.19 | $30.34 – $58.66 | 19,282 | 4 |
| Spindale, NC | $48.32 | $0.00 – $81.76 | 19,278 | 14 |
| Coalmont, TN | $34.48 | $24.29 – $37.47 | 19,273 | 2 |
| Chilton, WI | $39.17 | $13.50 – $39.76 | 19,273 | 9 |
| Waterford, WI | $33.87 | $5.27 – $60.40 | 19,269 | 22 |
| Commerce Twp, MI | $62.09 | $0.00 – $210.20 | 19,265 | 10 |
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.