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 |
|---|---|---|---|---|
| Unity, ME | $9.07 | $8.32 – $42.70 | 11,846 | 2 |
| Oroville, WA | $52.73 | $28.59 – $68.06 | 11,844 | 6 |
| Ensley, AL | $2.44 | $0.00 – $54.61 | 11,842 | 4 |
| North Bethesda, MD | $79.79 | $23.56 – $130.56 | 11,840 | 11 |
| Cashton, WI | $19.33 | $0.00 – $31.50 | 11,839 | 10 |
| Edinburgh, IN | $42.83 | $23.40 – $55.66 | 11,829 | 4 |
| Rushville, IL | $35.21 | $0.05 – $70.07 | 11,823 | 5 |
| Nowata, OK | $76.04 | $42.91 – $100.52 | 11,809 | 6 |
| Waterford, NJ | $14.98 | $14.98 – $14.98 | 11,808 | 1 |
| Rockwell City, IA | $10.80 | $0.03 – $61.14 | 11,806 | 4 |
| Pascoag, RI | $50.40 | $27.27 – $659.23 | 11,799 | 13 |
| Selma, TX | $59.41 | $43.96 – $92.79 | 11,791 | 5 |
| Toccoa, GA | $40.19 | $2.83 – $78.63 | 11,791 | 18 |
| Divide, CO | $176.17 | $76.15 – $189.95 | 11,790 | 2 |
| Pullman, MI | $2.88 | $2.88 – $2.88 | 11,779 | 1 |
| South Hamilton, MA | $43.25 | $0.00 – $58.55 | 11,775 | 11 |
| Westville, OK | $21.04 | $5.96 – $54.55 | 11,774 | 2 |
| Vienna, OH | $39.22 | $38.52 – $40.84 | 11,767 | 3 |
| Slaughter, LA | $27.16 | $3.87 – $27.22 | 11,767 | 2 |
| Waverly, VA | $54.98 | $25.89 – $64.23 | 11,766 | 3 |
| Brighton, TN | $36.35 | $4.66 – $47.59 | 11,763 | 9 |
| Farmington, IL | $1.92 | $0.00 – $51.56 | 11,762 | 3 |
| Turtle Creek, PA | $52.73 | $38.29 – $107.80 | 11,758 | 6 |
| Gilbert, SC | $61.03 | $58.42 – $76.56 | 11,742 | 4 |
| Okanogan, WA | $37.54 | $36.29 – $39.12 | 11,729 | 3 |
| Hugo, MN | $77.13 | $13.19 – $116.29 | 11,721 | 26 |
| Fosston, MN | $78.94 | $1.77 – $132.32 | 11,719 | 13 |
| Windcrest, TX | $34.48 | $22.83 – $43.74 | 11,711 | 6 |
| Benson, MN | $124.71 | $20.34 – $228.67 | 11,711 | 9 |
| Hamburg, IA | $6.70 | $0.00 – $23.06 | 11,708 | 8 |
| Homewood, AL | $54.90 | $13.23 – $177.93 | 11,705 | 18 |
| Shorewood, IL | $52.99 | $40.10 – $68.01 | 11,704 | 8 |
| Hermitage, MO | $80.24 | $14.15 – $144.98 | 11,697 | 6 |
| Talkeetna, AK | $209.53 | $0.00 – $496.05 | 11,692 | 7 |
| E Patchogue, NY | $86.12 | $57.06 – $94.90 | 11,691 | 7 |
| Platte City, MO | $55.80 | $17.53 – $87.03 | 11,690 | 11 |
| Coupeville, WA | $37.84 | $2.09 – $74.48 | 11,683 | 23 |
| Poland, ME | $29.54 | $17.88 – $43.38 | 11,677 | 7 |
| Terryville, CT | $56.28 | $10.63 – $59.94 | 11,675 | 4 |
| University, MS | $51.08 | $51.08 – $51.08 | 11,674 | 1 |
| Houghton, NY | $55.62 | $35.49 – $73.95 | 11,668 | 5 |
| Sayville, NY | $100.08 | $39.88 – $167.13 | 11,666 | 16 |
| Rockford, MI | $30.87 | $0.83 – $78.26 | 11,660 | 5 |
| Chilhowie, VA | $48.62 | $13.64 – $62.76 | 11,658 | 5 |
| Alton, MO | $59.48 | $16.66 – $75.59 | 11,655 | 4 |
| Claymont, DE | $8.10 | $0.00 – $77.41 | 11,644 | 13 |
| Grafton, VA | $63.13 | $42.41 – $76.13 | 11,644 | 9 |
| Saint Joseph, LA | $0.17 | $0.00 – $25.29 | 11,635 | 4 |
| Chinook, MT | $14.59 | $0.00 – $80.68 | 11,630 | 2 |
| Rutledge, TN | $30.53 | $28.45 – $61.56 | 11,630 | 4 |
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.