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 |
|---|---|---|---|---|
| White Bear Lake, MN | $59.58 | $15.29 – $77.86 | 17,302 | 35 |
| Saint Robert, MO | $72.06 | $30.41 – $93.50 | 17,298 | 11 |
| Holbrook, AZ | $43.95 | $0.04 – $91.96 | 17,256 | 6 |
| Perry, OK | $109.16 | $75.45 – $132.22 | 17,256 | 4 |
| Buda, TX | $48.77 | $3.49 – $329.42 | 17,254 | 16 |
| Fort Riley, KS | $52.60 | $0.00 – $477.40 | 17,248 | 15 |
| Honokaa, HI | $155.80 | $0.00 – $252.70 | 17,234 | 15 |
| Winthrop, ME | $38.13 | $25.99 – $77.24 | 17,234 | 9 |
| Whitesville, WV | $28.94 | $0.00 – $56.47 | 17,214 | 3 |
| Hanover, IN | $52.20 | $29.18 – $86.50 | 17,199 | 7 |
| Toxey, AL | $47.44 | $44.89 – $79.60 | 17,192 | 3 |
| Beaverton, MI | $14.48 | $11.20 – $41.48 | 17,188 | 3 |
| Clay Center, KS | $110.48 | $13.11 – $132.32 | 17,171 | 10 |
| Bexley, OH | $35.68 | $16.21 – $134.90 | 17,165 | 5 |
| Amargosa Valley, NV | $54.88 | $0.00 – $70.31 | 17,158 | 4 |
| Belmont, MA | $44.31 | $0.00 – $237.18 | 17,151 | 24 |
| Virginia Bch, VA | $71.60 | $56.65 – $90.63 | 17,148 | 3 |
| Kealakekua, HI | $91.20 | $0.00 – $259.08 | 17,127 | 16 |
| Milbridge, ME | $36.90 | $23.79 – $37.71 | 17,126 | 4 |
| Orcutt, CA | $47.85 | $1.95 – $48.10 | 17,105 | 3 |
| Hertford, NC | $34.68 | $29.68 – $70.82 | 17,099 | 3 |
| Beverly Hills, FL | $34.68 | $0.00 – $80.93 | 17,087 | 15 |
| Sellersville, PA | $43.90 | $0.00 – $119.76 | 17,081 | 52 |
| Parkesburg, PA | $35.06 | $8.66 – $48.58 | 17,066 | 8 |
| Wixom, MI | $78.65 | $78.65 – $78.65 | 17,064 | 1 |
| Monroe Township, NJ | $49.18 | $7.92 – $123.62 | 17,064 | 12 |
| Wyoming, MN | $58.34 | $38.70 – $83.74 | 17,064 | 37 |
| Weber City, VA | $43.01 | $14.83 – $55.20 | 17,055 | 5 |
| Gooding, ID | $54.11 | $0.27 – $459.42 | 17,049 | 17 |
| Solomons, MD | $106.73 | $46.23 – $174.82 | 17,044 | 15 |
| Shorewood, WI | $24.90 | $10.21 – $62.32 | 17,044 | 9 |
| Morris, MN | $53.53 | $1.11 – $162.81 | 17,036 | 25 |
| Southhaven, MS | $74.23 | $74.23 – $74.23 | 17,033 | 1 |
| Sudbury, MA | $30.35 | $1.81 – $193.68 | 17,028 | 18 |
| Oliver Springs, TN | $30.44 | $7.84 – $44.60 | 17,022 | 6 |
| Saint Ignatius, MT | $4.05 | $2.18 – $59.80 | 17,010 | 4 |
| Maryland Heights, MO | $58.77 | $12.91 – $101.73 | 17,000 | 22 |
| Thiensville, WI | $29.75 | $26.06 – $43.95 | 16,993 | 5 |
| Newbern, TN | $31.98 | $15.42 – $40.20 | 16,989 | 5 |
| South Webster, OH | $48.49 | $48.24 – $48.84 | 16,984 | 2 |
| Russell, KS | $101.87 | $18.64 – $151.88 | 16,984 | 10 |
| Wray, CO | $58.38 | $7.13 – $120.53 | 16,982 | 14 |
| Summerfield, NC | $64.74 | $14.83 – $94.63 | 16,977 | 14 |
| Roodhouse, IL | $0.04 | $0.02 – $0.04 | 16,947 | 2 |
| Arabi, LA | $0.52 | $0.00 – $54.95 | 16,944 | 2 |
| Monticello, IA | $4.76 | $0.01 – $52.02 | 16,934 | 6 |
| Lackawanna, NY | $43.72 | $0.00 – $95.24 | 16,934 | 12 |
| Tumon, GU | $84.03 | $84.03 – $84.03 | 16,927 | 1 |
| Rowland, NC | $47.88 | $40.67 – $65.66 | 16,922 | 4 |
| Reedsport, OR | $53.05 | $13.94 – $64.39 | 16,920 | 15 |
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.