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 |
|---|---|---|---|---|
| Burnsville, NC | $44.56 | $0.00 – $82.31 | 17,625 | 25 |
| Buckhorn, KY | $41.35 | $41.35 – $41.35 | 17,609 | 1 |
| Rosharon, TX | $44.49 | $41.84 – $45.39 | 17,604 | 2 |
| Chester, IL | $3.18 | $0.14 – $54.12 | 17,597 | 6 |
| Stamps, AR | $39.26 | $7.18 – $45.76 | 17,596 | 4 |
| Ida Grove, IA | $18.35 | $0.21 – $134.66 | 17,583 | 14 |
| Vevay, IN | $53.14 | $29.92 – $67.17 | 17,582 | 4 |
| Sachse, TX | $29.63 | $0.00 – $123.05 | 17,581 | 6 |
| Sparta, MO | $109.46 | $83.04 – $158.26 | 17,581 | 7 |
| Smithville, MS | $62.01 | $20.24 – $123.85 | 17,547 | 9 |
| Stanville, KY | $28.21 | $27.82 – $34.38 | 17,539 | 2 |
| Fort Totten, ND | $417.92 | $4.75 – $660.89 | 17,536 | 10 |
| Feeding Hills, MA | $39.84 | $12.82 – $61.94 | 17,534 | 13 |
| Hamilton Square, NJ | $33.77 | $12.68 – $93.06 | 17,534 | 11 |
| Maurepas, LA | $1.49 | $0.28 – $2.35 | 17,514 | 3 |
| Somerville, AL | $5.60 | $0.00 – $5.61 | 17,513 | 2 |
| New Market, VA | $54.11 | $5.43 – $79.43 | 17,495 | 7 |
| Richmond Hills, NY | $80.06 | $69.23 – $88.77 | 17,488 | 2 |
| Avon, CO | $97.51 | $0.00 – $245.16 | 17,485 | 30 |
| Blaine, TN | $45.55 | $33.65 – $59.67 | 17,466 | 5 |
| Watervliet, NY | $57.48 | $50.05 – $92.48 | 17,465 | 7 |
| Le Roy, NY | $58.77 | $33.08 – $131.76 | 17,454 | 11 |
| Mahomet, IL | $57.06 | $0.00 – $117.67 | 17,452 | 20 |
| Ringgold, LA | $0.01 | $0.00 – $0.29 | 17,444 | 4 |
| North Baldwin, NY | $62.17 | $11.14 – $157.54 | 17,440 | 7 |
| Osawatomie, KS | $139.69 | $26.76 – $170.12 | 17,432 | 11 |
| Richfield, MN | $108.33 | $8.75 – $318.75 | 17,430 | 47 |
| Snoqualmie, WA | $57.15 | $5.39 – $89.22 | 17,428 | 30 |
| Floyds Knobs, IN | $45.58 | $8.84 – $102.42 | 17,419 | 15 |
| Steelton, PA | $32.62 | $9.41 – $41.14 | 17,407 | 5 |
| Waterford, OH | $55.54 | $48.04 – $57.58 | 17,406 | 4 |
| Lexington, OH | $35.59 | $16.99 – $68.62 | 17,406 | 10 |
| Bean Station, TN | $34.19 | $22.40 – $35.04 | 17,372 | 4 |
| Lemont, IL | $51.89 | $11.96 – $95.45 | 17,372 | 12 |
| Chatham, VA | $43.33 | $17.07 – $76.10 | 17,368 | 7 |
| Hinton, OK | $91.82 | $69.78 – $113.87 | 17,368 | 5 |
| Eagle Grove, IA | $1.23 | $0.13 – $38.22 | 17,366 | 3 |
| Waterbury, VT | $12.93 | $0.00 – $35.31 | 17,363 | 11 |
| Waconia, MN | $52.39 | $19.83 – $238.65 | 17,361 | 59 |
| Newcastle, OK | $83.84 | $53.30 – $371.99 | 17,360 | 9 |
| Greenbrier, TN | $43.81 | $12.17 – $56.48 | 17,348 | 8 |
| Sardis, MS | $47.80 | $16.69 – $61.23 | 17,346 | 7 |
| Richmond Heights, OH | $44.89 | $1.44 – $112.12 | 17,344 | 22 |
| Arbuckle, CA | $5.58 | $0.00 – $21.53 | 17,341 | 4 |
| Forest City, IA | $25.76 | $22.48 – $31.06 | 17,334 | 8 |
| Bellevue, KY | $41.29 | $20.91 – $50.62 | 17,325 | 11 |
| Russells Point, OH | $33.76 | $0.71 – $46.58 | 17,315 | 7 |
| Sea Girt, NJ | $61.84 | $3.35 – $120.26 | 17,309 | 11 |
| Fort Sumner, NM | $96.99 | $31.95 – $139.59 | 17,308 | 5 |
| Crete, NE | $98.48 | $10.59 – $130.00 | 17,307 | 18 |
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.