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 |
|---|---|---|---|---|
| Pleasant Point, ME | $35.65 | $25.12 – $62.32 | 12,722 | 4 |
| Onamia, MN | $94.19 | $24.95 – $431.48 | 12,707 | 21 |
| Mcdaniels, KY | $28.32 | $27.88 – $29.86 | 12,707 | 2 |
| El Cerrito, CA | $22.25 | $0.00 – $122.77 | 12,701 | 7 |
| Mariposa, CA | $74.71 | $0.00 – $915.55 | 12,699 | 12 |
| Fort Knox, KY | $56.57 | $25.50 – $69.49 | 12,696 | 7 |
| Belle Vernon, PA | $46.72 | $13.74 – $67.96 | 12,690 | 25 |
| Granite Quarry, NC | $65.95 | $18.37 – $73.33 | 12,679 | 4 |
| Greenwood, AR | $64.09 | $32.72 – $470.40 | 12,679 | 10 |
| Southampton, PA | $45.90 | $3.49 – $155.21 | 12,660 | 22 |
| South Bloomfield, OH | $48.00 | $45.83 – $48.43 | 12,660 | 3 |
| South Ogden, UT | $43.92 | $12.07 – $71.33 | 12,656 | 18 |
| Gunnison, UT | $55.18 | $4.14 – $74.87 | 12,643 | 9 |
| Batchelor, LA | $0.02 | $0.00 – $0.03 | 12,638 | 3 |
| Pownal, VT | $18.57 | $16.75 – $38.49 | 12,634 | 4 |
| Wellston, OH | $48.14 | $42.81 – $55.28 | 12,610 | 3 |
| East Rockaway, NY | $55.03 | $15.54 – $107.85 | 12,609 | 10 |
| West Hatfield, MA | $49.04 | $30.73 – $81.71 | 12,600 | 9 |
| Brooksville, KY | $32.62 | $16.25 – $35.08 | 12,600 | 5 |
| Foster City, CA | $13.32 | $2.89 – $245.79 | 12,589 | 9 |
| Red Boiling Springs, TN | $25.96 | $23.81 – $31.19 | 12,586 | 2 |
| Alliance, NE | $56.69 | $20.33 – $163.38 | 12,579 | 15 |
| Lecompte, LA | $32.40 | $19.32 – $65.08 | 12,575 | 4 |
| Boothbay Harbor, ME | $27.82 | $19.18 – $67.09 | 12,574 | 4 |
| Oakland, TN | $33.32 | $5.56 – $45.78 | 12,571 | 4 |
| Kittery, ME | $39.64 | $16.11 – $81.99 | 12,571 | 20 |
| Bluff City, TN | $36.42 | $29.76 – $66.25 | 12,557 | 7 |
| Timmonsville, SC | $87.55 | $35.83 – $146.25 | 12,557 | 8 |
| Avilla, IN | $60.28 | $50.62 – $67.93 | 12,552 | 4 |
| Morton, WA | $36.49 | $15.22 – $56.61 | 12,549 | 9 |
| Kasigluk, AK | $287.09 | $0.00 – $441.44 | 12,548 | 8 |
| North Lauderdale, FL | $17.57 | $2.72 – $107.85 | 12,548 | 7 |
| Richmond, ME | $1.78 | $1.19 – $55.88 | 12,545 | 2 |
| Reserve, NM | $46.55 | $3.42 – $124.63 | 12,544 | 2 |
| Honea Path, SC | $60.46 | $18.00 – $72.98 | 12,538 | 7 |
| New Baltimore, MI | $56.72 | $56.72 – $56.72 | 12,526 | 1 |
| New Orleasns, LA | $35.25 | $35.25 – $35.25 | 12,517 | 1 |
| Eastport, ME | $2.42 | $1.67 – $427.41 | 12,508 | 3 |
| Strasburg, VA | $66.47 | $58.14 – $84.92 | 12,503 | 8 |
| Kutztown, PA | $67.61 | $20.68 – $71.56 | 12,495 | 6 |
| Hicksville, OH | $36.24 | $21.43 – $55.29 | 12,493 | 9 |
| Ashland, VA | $41.75 | $17.39 – $76.92 | 12,491 | 13 |
| Richland, MS | $63.05 | $7.57 – $327.75 | 12,477 | 14 |
| Trenton, KY | $29.64 | $22.13 – $46.18 | 12,470 | 4 |
| Petersburg, AK | $80.40 | $13.34 – $178.03 | 12,469 | 9 |
| Williamson, NY | $64.36 | $50.15 – $103.88 | 12,464 | 10 |
| Lexington Park, MD | $46.28 | $12.59 – $104.06 | 12,453 | 10 |
| Jefferson Valley, NY | $112.42 | $60.30 – $152.25 | 12,449 | 14 |
| Lic, NY | $38.60 | $17.48 – $46.77 | 12,436 | 2 |
| Broadview Hts, OH | $46.52 | $30.84 – $52.69 | 12,435 | 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.