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 |
|---|---|---|---|---|
| Rochdale, NY | $63.00 | $38.50 – $82.92 | 13,206 | 9 |
| Hudson Falls, NY | $85.32 | $60.19 – $100.41 | 13,201 | 6 |
| Bloomfield, MI | $56.20 | $55.92 – $68.22 | 13,193 | 2 |
| Floresville, TX | $58.71 | $0.00 – $95.54 | 13,178 | 20 |
| Carlisle, IA | $37.17 | $22.45 – $41.96 | 13,177 | 8 |
| Nashville, IL | $1.54 | $0.00 – $30.84 | 13,173 | 4 |
| Colleyville, TX | $44.16 | $3.04 – $654.00 | 13,152 | 13 |
| Hoisington, KS | $88.55 | $8.37 – $91.84 | 13,151 | 7 |
| Monteagle, TN | $29.00 | $19.30 – $37.00 | 13,145 | 7 |
| Lajunta, CO | $76.76 | $76.76 – $76.76 | 13,141 | 1 |
| Dryden, NY | $85.40 | $56.44 – $92.41 | 13,135 | 6 |
| Red Wing, MN | $43.05 | $16.82 – $124.48 | 13,132 | 34 |
| Rugby, ND | $210.87 | $69.99 – $383.75 | 13,130 | 13 |
| Windber, PA | $48.50 | $31.32 – $61.61 | 13,125 | 13 |
| Bangor, PA | $20.14 | $7.33 – $41.16 | 13,122 | 5 |
| Franklin, NJ | $26.48 | $1.91 – $68.10 | 13,122 | 6 |
| Perry, GA | $95.39 | $53.09 – $104.46 | 13,106 | 3 |
| Marion Center, PA | $42.96 | $42.21 – $43.26 | 13,106 | 3 |
| Swansea, SC | $53.78 | $44.93 – $63.71 | 13,104 | 12 |
| Waterloo, IL | $53.41 | $11.84 – $86.33 | 13,099 | 12 |
| Pawnee, OK | $145.32 | $50.44 – $689.80 | 13,096 | 12 |
| Anahuac, TX | $16.25 | $0.68 – $23.97 | 13,088 | 2 |
| Montpelier, ID | $1.75 | $0.00 – $99.69 | 13,083 | 10 |
| Byram, MS | $49.17 | $0.00 – $119.74 | 13,078 | 16 |
| Colebrook, NH | $46.29 | $0.00 – $110.71 | 13,077 | 11 |
| Newcastle, WA | $60.28 | $33.06 – $69.90 | 13,076 | 13 |
| Debary, FL | $39.04 | $0.00 – $130.47 | 13,074 | 17 |
| Marathon, FL | $41.32 | $12.87 – $71.34 | 13,073 | 12 |
| Cumberland Gap, TN | $43.19 | $29.71 – $46.15 | 13,066 | 3 |
| Shaker Hts, OH | $36.83 | $9.28 – $53.20 | 13,061 | 7 |
| Mccloud, CA | $5.97 | $0.02 – $206.07 | 13,058 | 5 |
| Jackson, MN | $87.43 | $26.37 – $197.91 | 13,056 | 16 |
| West St Paul, MN | $65.51 | $20.26 – $86.16 | 13,055 | 17 |
| Belle Mead, NJ | $41.36 | $10.79 – $143.59 | 13,053 | 8 |
| Lebec, CA | $41.64 | $2.97 – $722.77 | 13,050 | 4 |
| King,An, AZ | $43.94 | $43.94 – $43.94 | 13,046 | 1 |
| Leeds, ME | $9.90 | $1.91 – $66.45 | 13,042 | 7 |
| Aliceville, AL | $44.27 | $39.18 – $61.33 | 13,038 | 5 |
| Lake Linden, MI | $25.99 | $24.26 – $29.08 | 13,036 | 2 |
| Skiatook, OK | $88.06 | $62.40 – $96.09 | 13,026 | 8 |
| Hopkinton, MA | $37.45 | $3.13 – $76.63 | 13,020 | 24 |
| Williamsburg, OH | $23.96 | $22.30 – $33.58 | 13,012 | 3 |
| Rockland, ME | $35.24 | $16.05 – $150.97 | 13,001 | 15 |
| Eureka, MO | $65.26 | $32.09 – $95.73 | 12,991 | 11 |
| Oneida, WI | $34.17 | $0.00 – $53.97 | 12,989 | 13 |
| Glenburn, ME | $38.76 | $38.76 – $38.76 | 12,987 | 1 |
| Essex, MD | $74.92 | $21.27 – $209.33 | 12,986 | 14 |
| Cibolo, TX | $42.23 | $32.86 – $60.80 | 12,973 | 8 |
| Cross City, FL | $31.95 | $18.77 – $38.56 | 12,971 | 6 |
| Ft Carson, CO | $80.97 | $0.00 – $134.45 | 12,970 | 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.