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 |
|---|---|---|---|---|
| Northfield, VT | $40.15 | $8.83 – $109.46 | 11,377 | 13 |
| Bland, VA | $55.15 | $14.88 – $57.04 | 11,360 | 3 |
| Lenox, MI | $80.56 | $80.56 – $80.56 | 11,357 | 1 |
| Charlotte Court House, VA | $58.93 | $23.76 – $79.19 | 11,352 | 9 |
| Spring Creek, NV | $44.70 | $0.00 – $55.15 | 11,341 | 4 |
| West Berlin, NJ | $47.22 | $14.80 – $57.02 | 11,337 | 4 |
| Coburg, OR | $70.47 | $37.95 – $126.41 | 11,327 | 8 |
| Luverne, AL | $64.90 | $0.00 – $196.11 | 11,323 | 9 |
| Swanton, OH | $43.85 | $34.35 – $56.34 | 11,316 | 11 |
| Leesburg, AL | $43.27 | $0.00 – $50.93 | 11,316 | 5 |
| West Baden Springs, IN | $55.27 | $47.86 – $62.48 | 11,315 | 2 |
| Greenfield, MO | $94.00 | $15.54 – $118.76 | 11,297 | 4 |
| Bedford, NY | $55.61 | $55.61 – $55.61 | 11,293 | 1 |
| Half Moon Bay, CA | $56.87 | $0.00 – $1,497 | 11,291 | 12 |
| Hawley, PA | $14.06 | $0.74 – $48.62 | 11,289 | 6 |
| Whitesburg, TN | $48.59 | $23.92 – $52.94 | 11,289 | 3 |
| Castaic, CA | $5.56 | $0.05 – $64.04 | 11,287 | 4 |
| Cedar Point, NC | $47.57 | $36.43 – $53.66 | 11,284 | 8 |
| Mc Ewen, TN | $42.12 | $35.84 – $42.91 | 11,271 | 3 |
| Freeland, WA | $64.28 | $4.46 – $390.54 | 11,267 | 9 |
| Harwich Port, MA | $21.10 | $0.43 – $68.37 | 11,264 | 10 |
| Lawrenceville, PA | $1.27 | $0.00 – $1.72 | 11,254 | 4 |
| Quincy, WA | $47.79 | $0.00 – $68.63 | 11,251 | 9 |
| East Moline, IL | $13.73 | $0.00 – $68.40 | 11,248 | 5 |
| Gentry, AR | $41.33 | $13.58 – $101.91 | 11,238 | 5 |
| Emmalena, KY | $31.97 | $8.17 – $40.63 | 11,229 | 3 |
| Stafford Springs, CT | $39.02 | $5.81 – $116.04 | 11,225 | 15 |
| Old Lyme, CT | $60.73 | $10.37 – $82.86 | 11,213 | 12 |
| Kilauea, HI | $42.19 | $21.10 – $87.23 | 11,209 | 6 |
| El Campo, TX | $27.07 | $0.00 – $58.26 | 11,208 | 11 |
| Crab Orchard, WV | $34.09 | $25.84 – $64.34 | 11,199 | 2 |
| Chappaqua, NY | $85.09 | $0.00 – $142.72 | 11,198 | 11 |
| Lake Arthur, LA | $0.01 | $0.00 – $0.01 | 11,195 | 2 |
| Loxley, AL | $12.15 | $0.00 – $51.02 | 11,194 | 5 |
| Kuttawa, KY | $28.74 | $13.78 – $35.03 | 11,191 | 4 |
| Braddock, PA | $37.02 | $33.52 – $47.18 | 11,188 | 7 |
| Crescent City, FL | $64.50 | $0.00 – $107.62 | 11,181 | 6 |
| Mayaquez, PR | $0.64 | $0.33 – $1.94 | 11,180 | 2 |
| Falkville, AL | $8.40 | $0.00 – $8.48 | 11,178 | 2 |
| Covelo, CA | $0.05 | $0.00 – $0.05 | 11,174 | 3 |
| Loganville, GA | $108.42 | $13.90 – $437.78 | 11,167 | 17 |
| Nazareth, PA | $26.70 | $17.51 – $80.15 | 11,166 | 8 |
| Hull, MA | $10.98 | $3.59 – $74.71 | 11,163 | 4 |
| Laurys Station, PA | $35.91 | $17.50 – $60.36 | 11,160 | 11 |
| Barry, IL | $0.39 | $0.00 – $100.07 | 11,147 | 3 |
| Jesup, IA | $20.41 | $0.75 – $38.28 | 11,144 | 5 |
| Woodsville, NH | $32.50 | $0.04 – $75.14 | 11,139 | 14 |
| Minden, NV | $49.47 | $4.19 – $84.61 | 11,112 | 18 |
| Due West, SC | $65.28 | $30.89 – $74.31 | 11,111 | 5 |
| Marion, SC | $127.85 | $16.81 – $238.33 | 11,108 | 10 |
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.