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 |
|---|---|---|---|---|
| Dwight, IL | $48.01 | $0.00 – $60.69 | 18,859 | 5 |
| Linden, AL | $61.69 | $0.03 – $191.38 | 18,857 | 5 |
| Milford, MI | $60.34 | $39.69 – $78.69 | 18,824 | 8 |
| Lake Butler, FL | $31.15 | $0.00 – $116.08 | 18,820 | 8 |
| Cameron, MO | $53.15 | $30.77 – $80.95 | 18,807 | 18 |
| Lynn Haven, FL | $36.35 | $1.68 – $81.07 | 18,807 | 14 |
| Colcord, OK | $76.47 | $76.47 – $76.47 | 18,794 | 1 |
| Puxico, MO | $76.47 | $18.24 – $94.40 | 18,792 | 5 |
| Iowa, LA | $19.24 | $0.00 – $64.34 | 18,785 | 6 |
| Port St Joe, FL | $44.37 | $4.68 – $140.65 | 18,778 | 17 |
| Norton, OH | $31.15 | $12.37 – $44.81 | 18,778 | 16 |
| Huntsville, AR | $33.85 | $16.81 – $44.09 | 18,777 | 11 |
| Marengo, IA | $7.19 | $0.49 – $32.24 | 18,775 | 8 |
| Matteson, IL | $116.53 | $0.00 – $258.73 | 18,774 | 14 |
| New Town, ND | $351.99 | $0.00 – $611.68 | 18,774 | 18 |
| Rural Hall, NC | $56.29 | $0.00 – $66.23 | 18,767 | 17 |
| Whitefield, NH | $113.40 | $0.00 – $155.12 | 18,763 | 9 |
| Holton, KS | $120.66 | $20.97 – $173.04 | 18,748 | 13 |
| Syracuse, IN | $56.76 | $19.50 – $70.31 | 18,747 | 11 |
| Long Beach, MS | $55.59 | $5.40 – $109.43 | 18,743 | 16 |
| Loreauville, LA | $0.46 | $0.00 – $22.07 | 18,740 | 2 |
| Deckerville, MI | $11.33 | $8.41 – $64.99 | 18,737 | 4 |
| Onancock, VA | $36.52 | $12.88 – $73.73 | 18,733 | 19 |
| Mineral Ridge, OH | $58.97 | $45.22 – $81.51 | 18,732 | 4 |
| Mooreville, MS | $55.55 | $2.40 – $59.05 | 18,726 | 4 |
| South Bend, WA | $31.97 | $0.00 – $58.56 | 18,717 | 7 |
| Hillman, MI | $14.27 | $0.00 – $14.44 | 18,692 | 2 |
| Fort Valley, GA | $32.97 | $24.68 – $53.24 | 18,692 | 3 |
| Murphy, TX | $38.79 | $21.98 – $79.67 | 18,678 | 10 |
| Warrior, AL | $9.89 | $4.01 – $79.91 | 18,665 | 4 |
| Carriere, MS | $53.96 | $13.94 – $104.84 | 18,651 | 15 |
| Adel, GA | $38.56 | $7.21 – $38.58 | 18,636 | 3 |
| Palmhurst, TX | $38.76 | $38.76 – $38.76 | 18,625 | 1 |
| Jefferson, LA | $42.33 | $13.09 – $113.29 | 18,621 | 39 |
| Jamestown, OH | $35.66 | $4.44 – $91.58 | 18,604 | 15 |
| Centerton, AR | $44.40 | $23.41 – $173.35 | 18,603 | 16 |
| Estill Springs, TN | $47.25 | $39.00 – $64.09 | 18,600 | 4 |
| Hot Springs, SD | $79.11 | $0.00 – $82.30 | 18,596 | 6 |
| Middleburg, PA | $43.65 | $35.71 – $64.86 | 18,596 | 3 |
| Zion Crossroads, VA | $46.30 | $29.06 – $73.42 | 18,562 | 18 |
| Sidney, NE | $90.58 | $16.76 – $179.03 | 18,559 | 20 |
| Cliffwood, NJ | $37.85 | $31.48 – $60.91 | 18,551 | 3 |
| Northfield, IL | $87.74 | $21.07 – $121.65 | 18,543 | 12 |
| Thomson, GA | $55.02 | $0.00 – $82.29 | 18,536 | 8 |
| Acworth, GA | $60.18 | $7.92 – $130.01 | 18,535 | 19 |
| Taylorsville, MS | $43.79 | $8.37 – $103.13 | 18,514 | 9 |
| Annville, PA | $42.23 | $0.00 – $65.91 | 18,490 | 20 |
| Big Bear Lake, CA | $31.97 | $0.00 – $424.50 | 18,442 | 16 |
| Farmers Branch, TX | $30.20 | $3.64 – $54.86 | 18,434 | 11 |
| Conrad, MT | $25.68 | $0.00 – $110.62 | 18,413 | 5 |
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.