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 |
|---|---|---|---|---|
| Temple, PA | $76.65 | $29.34 – $100.12 | 13,876 | 9 |
| Oak Grove, KY | $15.69 | $8.17 – $33.00 | 13,875 | 3 |
| Mahopac, NY | $92.93 | $31.58 – $182.00 | 13,875 | 10 |
| Prosperity, SC | $71.99 | $27.40 – $151.19 | 13,875 | 6 |
| Gretna, NE | $58.01 | $26.79 – $229.88 | 13,874 | 22 |
| Thompson Falls, MT | $15.40 | $0.01 – $74.98 | 13,871 | 3 |
| Black Canyon City, AZ | $39.25 | $0.00 – $57.34 | 13,866 | 5 |
| W. St. Paul, MN | $220.27 | $27.04 – $253.39 | 13,866 | 10 |
| Mound Bayou, MS | $55.43 | $23.75 – $112.56 | 13,865 | 9 |
| Liberty, IN | $47.74 | $46.02 – $50.40 | 13,862 | 3 |
| Shawsville, VA | $60.52 | $40.06 – $62.38 | 13,853 | 3 |
| Jermyn, PA | $45.94 | $8.93 – $73.46 | 13,849 | 9 |
| Ritzville, WA | $52.37 | $2.30 – $81.82 | 13,832 | 10 |
| Magnolia, MS | $53.02 | $5.11 – $80.89 | 13,821 | 5 |
| Wallace, NC | $38.73 | $4.88 – $63.72 | 13,821 | 10 |
| Bohemia, NY | $64.08 | $0.00 – $158.56 | 13,815 | 11 |
| Eufaula, OK | $122.34 | $43.94 – $566.68 | 13,814 | 11 |
| Mars, PA | $51.98 | $30.20 – $75.68 | 13,805 | 13 |
| Corinth, NY | $61.70 | $54.79 – $70.93 | 13,798 | 6 |
| Ste Genevieve, MO | $86.22 | $16.33 – $134.38 | 13,792 | 19 |
| Hailey, ID | $39.91 | $2.56 – $232.68 | 13,761 | 21 |
| Walnut Ridge, AR | $31.39 | $0.02 – $130.63 | 13,748 | 13 |
| Wampsville, NY | $134.64 | $96.49 – $145.25 | 13,746 | 3 |
| Youngtown, AZ | $56.66 | $56.66 – $56.66 | 13,741 | 1 |
| Spring Grove, PA | $55.03 | $36.81 – $74.10 | 13,737 | 12 |
| Woodbury, CT | $36.14 | $20.00 – $38.59 | 13,736 | 3 |
| Cresson, PA | $48.39 | $45.90 – $52.31 | 13,734 | 6 |
| Hudson, NH | $43.59 | $17.69 – $82.86 | 13,731 | 27 |
| Brookneal, VA | $58.14 | $47.67 – $64.62 | 13,708 | 5 |
| Nebraska City, NE | $113.39 | $37.59 – $286.18 | 13,707 | 13 |
| Jesup, GA | $55.05 | $4.92 – $74.81 | 13,690 | 9 |
| Windermere, FL | $66.77 | $0.10 – $143.09 | 13,681 | 23 |
| Ellwood City, PA | $27.76 | $0.03 – $55.97 | 13,667 | 11 |
| Hayneville, AL | $20.50 | $0.00 – $217.65 | 13,665 | 3 |
| Mc Minnville, TN | $18.82 | $0.20 – $32.40 | 13,665 | 8 |
| Sauquoit, NY | $84.68 | $72.39 – $99.34 | 13,656 | 4 |
| Highland Park, CA | $10.83 | $0.15 – $599.50 | 13,655 | 4 |
| Saint Pauls, NC | $56.25 | $37.36 – $70.12 | 13,651 | 5 |
| Wilmore, KY | $37.83 | $23.63 – $49.25 | 13,627 | 8 |
| Danville, VT | $0.02 | $0.00 – $0.27 | 13,609 | 6 |
| Sac City, IA | $1.60 | $0.05 – $32.32 | 13,605 | 5 |
| Foxworth, MS | $58.78 | $19.10 – $103.35 | 13,593 | 5 |
| Colfax, LA | $22.12 | $0.00 – $39.93 | 13,591 | 3 |
| Culebra, PR | $0.11 | $0.07 – $2.66 | 13,588 | 2 |
| Palmetto, GA | $103.54 | $67.46 – $128.06 | 13,583 | 8 |
| Ramer, TN | $30.05 | $29.75 – $32.87 | 13,570 | 2 |
| Porter, OK | $11.93 | $0.54 – $91.59 | 13,569 | 5 |
| Edgerton, WI | $139.17 | $15.68 – $271.06 | 13,569 | 13 |
| Littlestown, PA | $52.64 | $44.26 – $53.65 | 13,562 | 6 |
| Brookfield, MO | $75.59 | $18.11 – $96.51 | 13,557 | 14 |
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.