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 |
|---|---|---|---|---|
| Hildebran, NC | $51.28 | $44.72 – $63.54 | 15,527 | 6 |
| Mercerville, NJ | $49.31 | $26.53 – $126.76 | 15,519 | 12 |
| St. Charles, VA | $43.92 | $12.81 – $51.18 | 15,510 | 3 |
| Tremonton, UT | $43.39 | $3.78 – $69.57 | 15,503 | 12 |
| Sesser, IL | $6.45 | $0.01 – $59.46 | 15,499 | 3 |
| Hughesville, PA | $39.37 | $35.30 – $48.78 | 15,497 | 3 |
| Green Cove Springs, FL | $49.71 | $6.77 – $124.94 | 15,493 | 10 |
| Oblong, IL | $0.01 | $0.01 – $0.01 | 15,479 | 1 |
| Marmora, NJ | $41.58 | $11.18 – $59.21 | 15,478 | 13 |
| Freeport, ME | $46.92 | $19.13 – $60.22 | 15,477 | 10 |
| Waterville, OH | $45.94 | $0.00 – $64.70 | 15,470 | 11 |
| Smithfield, KY | $36.83 | $36.23 – $189.66 | 15,458 | 2 |
| Damascus, OR | $61.18 | $56.64 – $108.87 | 15,457 | 4 |
| West Union, SC | $61.92 | $58.08 – $64.00 | 15,435 | 3 |
| Planada, CA | $1.05 | $0.00 – $1.06 | 15,434 | 3 |
| Hondo, TX | $11.97 | $0.00 – $120.17 | 15,425 | 12 |
| Koloa, HI | $39.33 | $13.82 – $123.57 | 15,423 | 8 |
| Neodesha, KS | $131.65 | $22.95 – $235.89 | 15,416 | 7 |
| Monmouth, ME | $14.90 | $2.03 – $57.60 | 15,412 | 8 |
| Smithsburg, MD | $87.00 | $59.04 – $100.22 | 15,398 | 10 |
| Booneville, AR | $44.53 | $20.50 – $639.62 | 15,398 | 15 |
| Buffalo, MO | $83.70 | $31.07 – $111.40 | 15,395 | 9 |
| Allendale, MI | $29.35 | $0.92 – $62.33 | 15,389 | 3 |
| Plainfield, VT | $14.63 | $0.00 – $58.29 | 15,389 | 11 |
| Section, AL | $0.35 | $0.00 – $0.86 | 15,388 | 4 |
| Airmont, NY | $108.00 | $50.58 – $143.42 | 15,375 | 14 |
| Hackberry, LA | $19.02 | $0.00 – $19.25 | 15,372 | 2 |
| Long Prairie, MN | $203.88 | $46.19 – $259.62 | 15,363 | 14 |
| Columbus, MT | $35.65 | $0.00 – $92.19 | 15,359 | 3 |
| Midfield, AL | $197.39 | $0.00 – $224.48 | 15,340 | 7 |
| Missouri Valley, IA | $8.37 | $0.00 – $128.85 | 15,323 | 11 |
| Franklin Park, IL | $48.20 | $24.11 – $63.99 | 15,315 | 7 |
| Eureka, IL | $16.87 | $0.29 – $66.75 | 15,313 | 5 |
| Everson, WA | $32.21 | $24.36 – $58.68 | 15,300 | 7 |
| Setauket, NY | $56.64 | $0.00 – $157.45 | 15,294 | 19 |
| Delavan, WI | $32.29 | $12.85 – $58.73 | 15,292 | 14 |
| Carrizo Springs, TX | $38.52 | $0.00 – $56.16 | 15,286 | 8 |
| Mattapan, MA | $43.96 | $0.84 – $55.88 | 15,282 | 11 |
| Brentwood, MO | $50.33 | $16.47 – $77.54 | 15,280 | 11 |
| Kaunakakai, HI | $122.35 | $17.13 – $369.20 | 15,267 | 13 |
| Liberty, NC | $51.43 | $20.15 – $82.47 | 15,261 | 9 |
| Brownville, ME | $4.26 | $4.26 – $4.26 | 15,260 | 1 |
| Lake Villa, IL | $45.21 | $0.00 – $70.88 | 15,256 | 11 |
| Sayre, OK | $87.88 | $52.56 – $179.01 | 15,249 | 7 |
| Sulligent, AL | $18.63 | $2.37 – $45.24 | 15,244 | 3 |
| Chesterfield, SC | $152.01 | $38.95 – $282.55 | 15,237 | 5 |
| Ballwin, MO | $46.38 | $21.58 – $248.98 | 15,214 | 23 |
| Scotch Plains, NJ | $56.62 | $8.75 – $80.20 | 15,206 | 13 |
| Columbus, NJ | $61.38 | $0.00 – $148.83 | 15,206 | 12 |
| Los Angles, CA | $0.14 | $0.10 – $0.63 | 15,204 | 2 |
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.