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 |
|---|---|---|---|---|
| Pooler, GA | $67.54 | $0.00 – $604.90 | 15,203 | 19 |
| Va Beach, VA | $56.27 | $14.42 – $107.86 | 15,200 | 24 |
| Spooner, WI | $56.39 | $15.20 – $83.69 | 15,190 | 15 |
| Dobbs Ferry, NY | $117.65 | $0.00 – $187.01 | 15,182 | 20 |
| Potomac, MD | $77.25 | $11.62 – $176.77 | 15,179 | 16 |
| Burnt Hills, NY | $68.77 | $53.45 – $163.43 | 15,179 | 24 |
| Catasauqua, PA | $17.25 | $2.51 – $52.68 | 15,176 | 4 |
| Wayland, NY | $66.94 | $59.34 – $84.71 | 15,174 | 5 |
| Washington Terrace, UT | $53.53 | $10.63 – $88.29 | 15,172 | 8 |
| Buford, GA | $89.24 | $0.00 – $259.96 | 15,165 | 19 |
| North Potomac, MD | $92.23 | $73.81 – $142.12 | 15,140 | 9 |
| Dawson Springs, KY | $37.81 | $15.26 – $42.25 | 15,139 | 4 |
| Palmyra, PA | $40.69 | $30.36 – $76.93 | 15,133 | 18 |
| Signal Mountain, TN | $37.20 | $11.92 – $53.71 | 15,127 | 18 |
| Gretna, VA | $54.75 | $0.00 – $61.79 | 15,126 | 9 |
| Peoria Heights, IL | $51.72 | $18.73 – $61.13 | 15,112 | 8 |
| Wautoma, WI | $31.27 | $13.74 – $42.27 | 15,091 | 15 |
| Cos Cob, CT | $45.63 | $34.66 – $93.49 | 15,080 | 7 |
| Arlington, KY | $22.73 | $10.49 – $22.76 | 15,073 | 2 |
| Saint James, NY | $84.37 | $51.50 – $126.84 | 15,066 | 6 |
| Grand Ronde, OR | $251.98 | $21.89 – $444.36 | 15,053 | 11 |
| Wellington, OH | $20.45 | $0.19 – $37.60 | 15,049 | 9 |
| Wallingford, PA | $43.37 | $43.32 – $44.98 | 15,035 | 2 |
| Oakland, ME | $37.53 | $11.32 – $79.23 | 15,033 | 20 |
| Eagle, CO | $59.53 | $54.27 – $100.15 | 15,029 | 10 |
| Gwynn Oak, MD | $126.59 | $84.30 – $176.77 | 15,026 | 8 |
| Liberty, NY | $72.81 | $12.20 – $143.11 | 15,019 | 10 |
| Iva, SC | $58.11 | $44.17 – $69.91 | 15,018 | 4 |
| Bellville, OH | $46.66 | $39.74 – $53.69 | 15,002 | 4 |
| Corozol, PR | $0.22 | $0.22 – $0.22 | 14,969 | 1 |
| Aberdeen, MS | $42.48 | $10.69 – $95.61 | 14,954 | 16 |
| Kingston, OK | $162.37 | $2.93 – $560.54 | 14,954 | 8 |
| Durham, CT | $25.76 | $0.00 – $90.84 | 14,947 | 9 |
| Falls City, NE | $83.84 | $20.17 – $243.71 | 14,945 | 11 |
| New Market, MD | $66.65 | $37.24 – $103.36 | 14,932 | 6 |
| Garland, UT | $57.36 | $48.06 – $76.62 | 14,922 | 7 |
| Newton Falls, OH | $33.28 | $3.22 – $47.76 | 14,915 | 6 |
| Augusta, KS | $53.99 | $18.14 – $163.06 | 14,905 | 13 |
| Selah, WA | $50.10 | $31.61 – $72.26 | 14,903 | 15 |
| Vienna, IL | $2.88 | $0.00 – $54.26 | 14,897 | 2 |
| Moon Twp, PA | $63.22 | $48.66 – $73.59 | 14,871 | 6 |
| Richmond Hts, OH | $38.98 | $22.78 – $318.75 | 14,868 | 10 |
| Bath, ME | $30.97 | $4.13 – $116.11 | 14,865 | 21 |
| Liberty, SC | $58.50 | $28.25 – $73.58 | 14,864 | 10 |
| Mathiston, MS | $41.09 | $28.45 – $74.88 | 14,860 | 3 |
| Leakesville, MS | $67.10 | $0.00 – $101.45 | 14,859 | 12 |
| Sumner, WA | $46.02 | $9.06 – $58.23 | 14,859 | 10 |
| Monona, WI | $49.50 | $12.70 – $192.93 | 14,858 | 32 |
| Watersmeet, MI | $21.93 | $21.43 – $51.89 | 14,857 | 5 |
| Columbia, IL | $52.32 | $30.60 – $86.63 | 14,855 | 17 |
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.