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 |
|---|---|---|---|---|
| Hollandale, MS | $39.83 | $9.39 – $68.09 | 14,254 | 7 |
| Camano Island, WA | $55.05 | $13.06 – $67.90 | 14,253 | 7 |
| Walnut Grove, MS | $57.10 | $21.24 – $94.91 | 14,244 | 5 |
| Pecos, NM | $71.19 | $1.22 – $318.75 | 14,239 | 8 |
| Uncasville, CT | $34.74 | $0.00 – $54.96 | 14,215 | 19 |
| Fitzgerald, GA | $56.43 | $18.07 – $60.43 | 14,215 | 5 |
| Fredonia, NY | $65.47 | $37.17 – $75.14 | 14,211 | 14 |
| Newton, IL | $21.54 | $0.00 – $60.99 | 14,208 | 10 |
| Severn, MD | $85.60 | $0.07 – $149.62 | 14,205 | 9 |
| Lincoln, MA | $32.37 | $32.37 – $32.37 | 14,187 | 1 |
| Lynden, WA | $13.70 | $3.07 – $113.74 | 14,182 | 18 |
| Wiscasset, ME | $42.35 | $33.34 – $76.74 | 14,180 | 13 |
| Gibbsboro, NJ | $72.62 | $19.26 – $79.56 | 14,176 | 10 |
| Osseo, WI | $19.06 | $11.74 – $45.91 | 14,155 | 12 |
| Garrettsville, OH | $44.04 | $25.05 – $73.71 | 14,145 | 10 |
| Copiague, NY | $75.09 | $34.85 – $191.45 | 14,141 | 7 |
| New Holland, PA | $18.93 | $0.00 – $78.73 | 14,137 | 12 |
| Rocky Top, TN | $48.81 | $30.03 – $59.24 | 14,131 | 4 |
| Bklyn, NY | $66.34 | $19.28 – $214.17 | 14,129 | 5 |
| Pocahontas, IA | $0.15 | $0.06 – $24.22 | 14,123 | 3 |
| Calumet, MI | $36.29 | $36.15 – $179.62 | 14,121 | 2 |
| Malad City, ID | $45.69 | $0.00 – $366.78 | 14,120 | 12 |
| Guthrie, KY | $49.51 | $35.60 – $70.24 | 14,118 | 3 |
| Little Egg Harbor Twp, NJ | $37.40 | $1.91 – $42.34 | 14,107 | 6 |
| Browns Mills, NJ | $43.42 | $3.33 – $99.15 | 14,098 | 20 |
| Palmerton, PA | $100.79 | $0.00 – $833.97 | 14,092 | 15 |
| Olathe, CO | $208.94 | $195.63 – $240.73 | 14,086 | 3 |
| Oxford, MA | $39.44 | $10.57 – $45.06 | 14,082 | 5 |
| Helena, AL | $31.11 | $0.00 – $49.41 | 14,076 | 7 |
| Rolling Meadows, IL | $32.83 | $0.00 – $90.98 | 14,075 | 27 |
| Nephi, UT | $62.26 | $4.18 – $69.86 | 14,052 | 14 |
| Indian Wells, CA | $37.10 | $0.00 – $43.78 | 14,043 | 9 |
| Pequannock, NJ | $47.62 | $4.34 – $57.00 | 14,040 | 4 |
| North Haledon, NJ | $64.07 | $27.51 – $73.08 | 14,019 | 2 |
| Meadowview, VA | $48.26 | $23.77 – $76.90 | 14,006 | 7 |
| Riverdale, NJ | $64.94 | $27.30 – $85.30 | 14,002 | 10 |
| Mancos, CO | $135.04 | $55.21 – $248.15 | 14,000 | 6 |
| Limerick, PA | $45.60 | $0.00 – $122.69 | 13,999 | 18 |
| Weaverville, NC | $49.04 | $10.58 – $139.57 | 13,996 | 23 |
| Coolville, OH | $28.36 | $0.79 – $32.99 | 13,986 | 5 |
| Tysons, VA | $96.18 | $55.53 – $104.68 | 13,959 | 7 |
| Wilmington, MA | $42.22 | $2.32 – $132.80 | 13,941 | 24 |
| Quinton, VA | $49.03 | $10.70 – $61.11 | 13,930 | 4 |
| Two Harbors, MN | $67.22 | $17.29 – $92.09 | 13,923 | 11 |
| Kelso, WA | $33.88 | $0.00 – $56.64 | 13,917 | 8 |
| Eastern, KY | $34.85 | $29.04 – $36.53 | 13,917 | 2 |
| Larned, KS | $180.86 | $13.74 – $603.92 | 13,914 | 10 |
| Morganville, NJ | $51.33 | $8.21 – $85.62 | 13,908 | 14 |
| Woodmere, OH | $34.69 | $9.58 – $58.79 | 13,900 | 18 |
| Middle River, MD | $121.59 | $22.64 – $152.32 | 13,882 | 12 |
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.