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 |
|---|---|---|---|---|
| Lv, NV | $68.92 | $68.92 – $68.92 | 12,958 | 1 |
| Hudson, MA | $37.41 | $2.86 – $99.51 | 12,957 | 13 |
| Hays, NC | $29.70 | $17.37 – $31.14 | 12,955 | 4 |
| Glenn Allen, VA | $17.11 | $17.11 – $17.11 | 12,953 | 1 |
| Barrington, NH | $37.10 | $2.82 – $59.35 | 12,950 | 16 |
| Lockesburg, AR | $34.14 | $24.04 – $37.20 | 12,942 | 3 |
| S Charleston, WV | $44.44 | $27.91 – $66.61 | 12,928 | 3 |
| Amelia, VA | $57.11 | $45.16 – $72.52 | 12,903 | 4 |
| Guthrie Center, IA | $28.57 | $2.78 – $37.75 | 12,898 | 14 |
| Branford, FL | $29.63 | $0.00 – $45.44 | 12,898 | 12 |
| Westwego, LA | $20.50 | $0.00 – $44.45 | 12,895 | 5 |
| Aloha, OR | $73.66 | $2.20 – $122.28 | 12,895 | 10 |
| Burlington, IA | $31.97 | $13.89 – $64.37 | 12,894 | 13 |
| Powdersville, SC | $58.71 | $47.78 – $76.20 | 12,888 | 4 |
| West Hazleton, PA | $55.06 | $30.17 – $72.29 | 12,885 | 4 |
| Charlotte Couthhouse, VA | $53.40 | $53.40 – $53.40 | 12,882 | 1 |
| Caledonia, NY | $77.03 | $67.78 – $93.21 | 12,880 | 6 |
| Sun City Center, FL | $29.27 | $0.94 – $86.23 | 12,879 | 21 |
| Goshen, OH | $64.59 | $36.80 – $71.91 | 12,879 | 4 |
| Hartville, OH | $37.26 | $21.98 – $53.35 | 12,878 | 5 |
| Point Reyes, CA | $1.32 | $1.32 – $1.32 | 12,865 | 1 |
| Sandersville, GA | $55.60 | $5.89 – $81.88 | 12,861 | 5 |
| Laurel, MT | $85.32 | $62.26 – $153.04 | 12,859 | 7 |
| North Branford, CT | $52.46 | $0.43 – $80.73 | 12,848 | 6 |
| Morrow, GA | $60.64 | $0.00 – $111.50 | 12,847 | 14 |
| Villa Park, IL | $57.21 | $45.58 – $61.03 | 12,847 | 3 |
| Sergeant Bluff, IA | $35.48 | $31.94 – $44.47 | 12,846 | 3 |
| Kapaa, HI | $40.93 | $17.35 – $140.40 | 12,838 | 12 |
| Lake Stevens, WA | $58.72 | $26.08 – $83.55 | 12,829 | 14 |
| Rathdrum, ID | $45.90 | $0.00 – $71.58 | 12,825 | 10 |
| White Pine, TN | $39.19 | $32.16 – $43.87 | 12,824 | 5 |
| Marietta, OK | $115.79 | $0.00 – $386.29 | 12,824 | 6 |
| Glen Mills, PA | $39.19 | $5.12 – $113.16 | 12,818 | 32 |
| New York Mills, NY | $73.83 | $73.67 – $124.55 | 12,811 | 2 |
| Aynor, SC | $52.55 | $0.00 – $61.21 | 12,794 | 6 |
| Minot Afb, ND | $44.77 | $38.46 – $85.93 | 12,771 | 4 |
| Harts, WV | $8.06 | $0.35 – $30.26 | 12,769 | 3 |
| Eagle Mountain, UT | $68.05 | $7.36 – $80.51 | 12,768 | 16 |
| Juau Diaz, PR | $48.21 | $48.21 – $48.21 | 12,766 | 1 |
| Chase City, VA | $51.54 | $16.46 – $67.45 | 12,757 | 10 |
| Dayton, TX | $30.03 | $0.73 – $36.53 | 12,755 | 4 |
| Aberdeen, NC | $58.75 | $26.36 – $63.09 | 12,754 | 7 |
| Appomattox, VA | $43.38 | $11.69 – $61.27 | 12,753 | 11 |
| Franklin Township, NJ | $87.19 | $87.19 – $87.19 | 12,747 | 1 |
| Nunda, NY | $61.84 | $48.74 – $91.64 | 12,744 | 5 |
| Nellysford, VA | $47.89 | $41.92 – $63.60 | 12,741 | 6 |
| Lubec, ME | $5.54 | $5.54 – $5.54 | 12,739 | 1 |
| Milo, ME | $11.34 | $9.40 – $34.70 | 12,737 | 2 |
| Alamo, NM | $437.15 | $437.15 – $437.15 | 12,736 | 1 |
| Ballston Spa, NY | $67.33 | $56.63 – $85.49 | 12,725 | 13 |
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.