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 |
|---|---|---|---|---|
| District Heights, MD | $77.49 | $0.00 – $122.15 | 12,134 | 9 |
| Brimley, MI | $13.73 | $13.46 – $17.33 | 12,131 | 2 |
| Odon, IN | $56.77 | $31.24 – $74.93 | 12,130 | 7 |
| Center Point, AL | $1.18 | $0.00 – $66.19 | 12,117 | 7 |
| Muncy, PA | $38.91 | $28.25 – $74.84 | 12,109 | 13 |
| Oakland City, IN | $50.14 | $31.14 – $58.10 | 12,095 | 6 |
| New Hampton, IA | $23.44 | $8.90 – $35.98 | 12,092 | 12 |
| Anna, TX | $41.48 | $31.60 – $45.44 | 12,090 | 3 |
| Casselberry, FL | $26.23 | $0.00 – $61.77 | 12,088 | 16 |
| South Easton, MA | $48.97 | $34.91 – $90.44 | 12,086 | 10 |
| Landrum, SC | $56.53 | $15.28 – $65.91 | 12,085 | 8 |
| Wakeman, OH | $45.80 | $33.20 – $49.36 | 12,085 | 6 |
| Westwood, KS | $58.71 | $12.02 – $122.86 | 12,082 | 27 |
| Palatine Bridge, NY | $103.09 | $103.09 – $103.09 | 12,074 | 1 |
| Grangeville, ID | $113.75 | $0.00 – $683.77 | 12,073 | 13 |
| Terrell, TX | $39.83 | $1.94 – $50.75 | 12,070 | 9 |
| Fruitland, MD | $79.42 | $4.19 – $135.74 | 12,060 | 3 |
| Jbsa Lackland, TX | $59.74 | $0.00 – $106.98 | 12,058 | 18 |
| Great Falls, SC | $52.91 | $49.74 – $55.46 | 12,039 | 3 |
| Highland Falls, NY | $45.91 | $16.68 – $67.13 | 12,037 | 2 |
| Bowman, GA | $71.94 | $57.33 – $113.24 | 12,031 | 6 |
| Louisville, TN | $43.27 | $30.20 – $59.42 | 12,015 | 7 |
| Obetz, OH | $52.20 | $52.20 – $52.20 | 12,005 | 1 |
| Julesburg, CO | $125.56 | $69.52 – $172.05 | 11,987 | 8 |
| Blair, NE | $108.36 | $29.93 – $223.76 | 11,986 | 16 |
| Nine Mile Falls, WA | $67.48 | $19.78 – $74.17 | 11,985 | 3 |
| Mendon, NY | $68.92 | $65.81 – $71.80 | 11,985 | 4 |
| Amherst, NH | $56.89 | $6.21 – $92.52 | 11,984 | 17 |
| Haynesville, LA | $2.25 | $0.13 – $18.63 | 11,984 | 3 |
| Conrad, IA | $8.86 | $0.24 – $28.11 | 11,969 | 3 |
| Albany, MO | $48.65 | $32.91 – $67.58 | 11,966 | 5 |
| Pierson, FL | $69.27 | $59.70 – $72.88 | 11,965 | 5 |
| Plymouthy, NC | $33.03 | $33.03 – $33.03 | 11,953 | 1 |
| Marysville, KS | $136.43 | $26.57 – $160.43 | 11,952 | 7 |
| Elfrida, AZ | $42.44 | $0.16 – $70.38 | 11,944 | 5 |
| Cass Lake, MN | $329.40 | $0.00 – $645.47 | 11,942 | 23 |
| Gila Bend, AZ | $27.06 | $0.04 – $95.54 | 11,940 | 3 |
| Otsego, MN | $84.43 | $45.31 – $170.12 | 11,929 | 16 |
| Bon Aqua, TN | $35.94 | $35.94 – $35.94 | 11,918 | 1 |
| Doylestown, OH | $40.81 | $20.23 – $58.60 | 11,914 | 5 |
| Gravette, AR | $49.22 | $25.51 – $138.04 | 11,907 | 12 |
| Forest Lake, MN | $74.81 | $29.12 – $109.82 | 11,906 | 21 |
| Roseland, NJ | $40.09 | $7.61 – $50.24 | 11,904 | 6 |
| Linthicum Heights, MD | $96.79 | $3.78 – $135.90 | 11,901 | 8 |
| Pleasanton, KS | $150.99 | $0.00 – $173.02 | 11,881 | 8 |
| Garden City, ID | $52.53 | $7.09 – $97.09 | 11,879 | 9 |
| Plymouth, NC | $54.70 | $22.69 – $86.21 | 11,879 | 12 |
| Loretto, PA | $51.88 | $51.88 – $51.88 | 11,871 | 1 |
| Concord, VT | $9.42 | $0.00 – $24.51 | 11,863 | 4 |
| Pearl City, HI | $26.15 | $2.23 – $166.72 | 11,850 | 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.