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 |
|---|---|---|---|---|
| American Falls, ID | $31.42 | $0.19 – $64.61 | 13,546 | 7 |
| Robbinsville, NC | $30.00 | $0.00 – $225.00 | 13,543 | 14 |
| Sayreville, NJ | $35.01 | $33.40 – $71.29 | 13,529 | 2 |
| Moundville, AL | $3.34 | $0.00 – $33.50 | 13,528 | 4 |
| Hampstead, NH | $47.98 | $34.18 – $79.07 | 13,514 | 6 |
| S. Richmond Hill, NY | $64.51 | $64.51 – $64.51 | 13,507 | 1 |
| Fairfax Station, VA | $67.73 | $38.73 – $68.71 | 13,504 | 4 |
| Castroville, TX | $37.36 | $34.68 – $41.05 | 13,490 | 4 |
| Saint Louis Park, MN | $70.27 | $16.55 – $125.49 | 13,486 | 29 |
| East Hampton, CT | $46.21 | $16.67 – $69.32 | 13,477 | 10 |
| Haymarket, VA | $60.67 | $34.52 – $97.75 | 13,473 | 19 |
| St Maries, ID | $25.74 | $0.00 – $92.49 | 13,462 | 14 |
| Alpine, NJ | $38.83 | $38.83 – $38.83 | 13,456 | 1 |
| New Palestine, IN | $62.43 | $41.03 – $322.57 | 13,454 | 9 |
| Gardner, KS | $43.36 | $11.80 – $69.57 | 13,454 | 19 |
| Lincoln, AL | $8.77 | $0.00 – $59.32 | 13,452 | 9 |
| Lapel, IN | $62.43 | $45.43 – $73.84 | 13,451 | 9 |
| Franklin, MI | $84.82 | $84.48 – $88.33 | 13,450 | 2 |
| Benton, TN | $37.24 | $30.05 – $60.43 | 13,437 | 8 |
| Camilla, GA | $39.02 | $1.82 – $68.93 | 13,435 | 8 |
| Chamberlain, SD | $48.71 | $19.14 – $102.52 | 13,428 | 5 |
| Keego Harbor, MI | $53.49 | $53.49 – $53.55 | 13,427 | 2 |
| Heflin, AL | $26.96 | $0.00 – $230.73 | 13,414 | 8 |
| Turner, ME | $6.65 | $0.00 – $43.76 | 13,395 | 5 |
| Saint Charles, IL | $55.06 | $25.27 – $159.37 | 13,387 | 10 |
| Lykens, PA | $36.98 | $35.48 – $76.63 | 13,386 | 3 |
| Stroud, OK | $118.89 | $27.02 – $546.20 | 13,386 | 10 |
| Hamburg, PA | $46.79 | $43.69 – $60.20 | 13,380 | 13 |
| Malta, MT | $7.51 | $0.00 – $89.90 | 13,378 | 3 |
| Ligonier, IN | $51.80 | $31.15 – $55.69 | 13,374 | 4 |
| Belfry, KY | $26.32 | $2.05 – $69.07 | 13,369 | 6 |
| Crisfield, MD | $67.26 | $25.48 – $99.93 | 13,366 | 8 |
| Vineyard, UT | $53.87 | $43.96 – $94.79 | 13,360 | 13 |
| Leadville, CO | $83.21 | $32.53 – $174.09 | 13,346 | 11 |
| Mt Pleasant, UT | $56.83 | $26.50 – $77.22 | 13,343 | 10 |
| Ortonville, MN | $30.17 | $14.22 – $50.65 | 13,325 | 16 |
| Levittown, PA | $39.42 | $0.74 – $100.88 | 13,299 | 33 |
| Brookville, OH | $49.46 | $32.47 – $64.59 | 13,295 | 13 |
| Sauk Centre, MN | $147.22 | $30.43 – $300.56 | 13,290 | 16 |
| Bridgeville, PA | $76.79 | $17.74 – $101.62 | 13,289 | 16 |
| North Garden, VA | $52.81 | $36.29 – $73.05 | 13,278 | 7 |
| Double Springs, AL | $49.91 | $0.00 – $193.78 | 13,264 | 8 |
| Port Allegany, PA | $0.43 | $0.00 – $0.48 | 13,263 | 3 |
| Stedman, NC | $31.53 | $28.83 – $37.41 | 13,255 | 4 |
| Hollywood, CA | $8.89 | $0.00 – $33.15 | 13,251 | 6 |
| Hana, HI | $55.96 | $41.82 – $181.53 | 13,240 | 3 |
| Saint Marys, PA | $54.12 | $0.00 – $77.00 | 13,228 | 11 |
| West Lake Hills, TX | $38.46 | $0.00 – $119.28 | 13,216 | 24 |
| New Haven, IN | $60.33 | $45.73 – $83.37 | 13,207 | 9 |
| Rochdale, NY | $63.00 | $38.50 – $82.92 | 13,206 | 9 |
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.