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 |
|---|---|---|---|---|
| Hayfork, CA | $2.18 | $2.18 – $2.18 | 11,626 | 1 |
| Palmyra, VA | $58.78 | $11.69 – $68.16 | 11,625 | 10 |
| Powell, WY | $57.00 | $0.00 – $155.69 | 11,625 | 28 |
| Bunker Hill, IL | $0.00 | $0.00 – $0.00 | 11,618 | 1 |
| Saline, MI | $48.86 | $12.58 – $278.10 | 11,618 | 10 |
| Chiloquin, OR | $213.74 | $73.33 – $540.35 | 11,606 | 7 |
| Albion, IN | $61.32 | $34.04 – $82.03 | 11,604 | 4 |
| Clover, SC | $58.43 | $23.51 – $70.36 | 11,603 | 8 |
| Galena, KS | $42.86 | $32.59 – $77.62 | 11,602 | 20 |
| Cutler, CA | $11.42 | $6.79 – $29.46 | 11,601 | 3 |
| Gate City, VA | $49.55 | $27.75 – $66.26 | 11,598 | 6 |
| Grosse Ile, MI | $56.91 | $44.17 – $57.66 | 11,589 | 2 |
| N Tonawanda, NY | $63.50 | $48.16 – $82.48 | 11,585 | 6 |
| Egg Harbor Twp, NJ | $69.14 | $6.67 – $141.63 | 11,569 | 8 |
| Beverly Hills, MI | $67.56 | $37.04 – $68.04 | 11,546 | 4 |
| Okemah, OK | $190.31 | $67.50 – $567.14 | 11,532 | 6 |
| Lindenwold, NJ | $48.23 | $21.32 – $83.34 | 11,532 | 8 |
| Oquawka, IL | $1.40 | $0.16 – $33.14 | 11,530 | 2 |
| El Paso, IL | $34.14 | $0.00 – $71.07 | 11,529 | 6 |
| Saint Clair, MO | $45.31 | $9.29 – $112.60 | 11,520 | 7 |
| Timnath, CO | $73.66 | $40.96 – $98.54 | 11,514 | 12 |
| Norwood, OH | $41.31 | $21.23 – $54.96 | 11,510 | 11 |
| Corning, IA | $6.15 | $0.00 – $45.35 | 11,508 | 6 |
| Sparta, MI | $27.39 | $1.31 – $235.18 | 11,507 | 4 |
| Gladstone, MI | $34.62 | $0.00 – $34.74 | 11,495 | 2 |
| Vauxhall, NJ | $44.83 | $20.04 – $104.12 | 11,490 | 9 |
| Dixfield, ME | $17.92 | $17.92 – $17.92 | 11,485 | 1 |
| Wheatfield, IN | $45.63 | $30.70 – $68.36 | 11,478 | 7 |
| Bonita, CA | $27.59 | $1.05 – $96.46 | 11,469 | 15 |
| Surf City, NC | $46.34 | $0.83 – $70.30 | 11,468 | 7 |
| Union City, OH | $42.96 | $42.96 – $42.96 | 11,453 | 1 |
| Brooksville, MS | $53.54 | $10.00 – $69.25 | 11,451 | 4 |
| Cleveland, GA | $60.82 | $29.84 – $132.33 | 11,449 | 7 |
| Manchester, MD | $121.15 | $94.31 – $164.75 | 11,448 | 5 |
| Gas City, IN | $53.36 | $47.94 – $64.82 | 11,447 | 3 |
| Clifton, TN | $35.06 | $30.95 – $38.27 | 11,445 | 3 |
| Croton On Hudson, NY | $110.87 | $26.17 – $175.32 | 11,440 | 14 |
| Coulterville, IL | $11.67 | $0.01 – $66.57 | 11,437 | 3 |
| Louisville, IL | $3.02 | $0.00 – $46.92 | 11,436 | 4 |
| Giddings, TX | $35.58 | $33.33 – $42.82 | 11,433 | 4 |
| Garnett, KS | $157.09 | $1.07 – $202.62 | 11,427 | 5 |
| Hampden, ME | $34.46 | $20.43 – $48.88 | 11,422 | 10 |
| Meadowbrook, PA | $46.65 | $0.00 – $133.95 | 11,415 | 30 |
| Kingston, WA | $45.14 | $21.45 – $67.74 | 11,410 | 10 |
| Oak Harbor, OH | $62.45 | $32.23 – $119.70 | 11,403 | 6 |
| Aspen Hill, MD | $49.31 | $49.28 – $75.86 | 11,395 | 2 |
| Cornwall, NY | $73.65 | $3.14 – $109.17 | 11,393 | 12 |
| Allison Park, PA | $51.35 | $4.78 – $93.92 | 11,387 | 16 |
| Brooklyn, MS | $107.18 | $49.85 – $134.66 | 11,387 | 4 |
| Huntingtown, MD | $96.26 | $0.00 – $107.36 | 11,385 | 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.