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 |
|---|---|---|---|---|
| Hartland, WI | $36.63 | $24.34 – $74.13 | 11,107 | 20 |
| Chapel Hill, TN | $44.78 | $15.83 – $59.40 | 11,099 | 4 |
| East Elmhurst, NY | $63.64 | $30.75 – $186.70 | 11,095 | 9 |
| Mill City, OR | $70.43 | $53.51 – $111.31 | 11,094 | 6 |
| Pilot Knob, MO | $72.16 | $33.59 – $118.61 | 11,092 | 9 |
| Cordes Lakes, AZ | $51.76 | $51.76 – $51.76 | 11,091 | 1 |
| Huxley, IA | $36.42 | $5.97 – $37.49 | 11,085 | 4 |
| Galva, IL | $0.49 | $0.00 – $23.79 | 11,076 | 2 |
| Bluffton, OH | $49.04 | $5.48 – $230.81 | 11,075 | 14 |
| Fitchburg, WI | $28.78 | $12.18 – $69.38 | 11,072 | 38 |
| Racine, OH | $26.52 | $0.27 – $43.16 | 11,070 | 4 |
| Oneida, KY | $31.81 | $28.24 – $38.02 | 11,067 | 2 |
| Elizabeth, IN | $56.94 | $56.85 – $60.64 | 11,061 | 2 |
| Byron Center, MI | $42.00 | $8.89 – $247.06 | 11,059 | 8 |
| Atco, NJ | $30.08 | $1.47 – $53.03 | 11,058 | 5 |
| Hickory Flat, MS | $41.08 | $21.97 – $42.71 | 11,056 | 2 |
| Oglethorpe, GA | $56.81 | $56.81 – $56.81 | 11,056 | 1 |
| Wheeler, OR | $34.41 | $12.14 – $77.31 | 11,054 | 6 |
| New Castle, CO | $68.71 | $42.69 – $75.06 | 11,052 | 5 |
| Sammamish, WA | $57.47 | $15.98 – $119.14 | 11,050 | 21 |
| Ballston Lake, NY | $62.75 | $18.86 – $112.81 | 11,048 | 15 |
| Stevensville, MI | $43.09 | $12.90 – $64.92 | 11,048 | 4 |
| Colmar Manor, MD | $68.85 | $9.26 – $100.06 | 11,042 | 9 |
| Campti, LA | $2.54 | $2.54 – $2.54 | 11,038 | 1 |
| Lockwood, MO | $67.06 | $29.43 – $97.71 | 11,028 | 8 |
| Calico Rock, AR | $24.33 | $0.00 – $28.70 | 11,021 | 5 |
| Traer, IA | $29.75 | $27.78 – $30.02 | 11,014 | 2 |
| Rolling Fork, MS | $34.18 | $0.00 – $101.73 | 11,013 | 13 |
| Demotte, IN | $36.90 | $0.00 – $97.61 | 11,012 | 11 |
| Milford, IL | $2.46 | $0.02 – $62.25 | 11,009 | 3 |
| Eglin Afb, FL | $79.66 | $15.64 – $186.64 | 11,006 | 21 |
| Kingfield, ME | $8.84 | $0.92 – $43.44 | 11,003 | 3 |
| Drumright, OK | $133.84 | $124.74 – $194.74 | 10,995 | 4 |
| Jbphh, HI | $26.28 | $0.67 – $284.55 | 10,994 | 9 |
| Sharon, CT | $45.35 | $5.80 – $71.69 | 10,992 | 15 |
| Harwich, MA | $49.55 | $6.81 – $74.46 | 10,982 | 20 |
| Prescott, AR | $28.56 | $24.86 – $40.72 | 10,980 | 6 |
| West Harrison, NY | $116.68 | $74.66 – $182.15 | 10,973 | 9 |
| Mather, CA | $7.79 | $0.00 – $145.91 | 10,970 | 12 |
| Sunny Isl Bch, FL | $86.96 | $86.96 – $86.96 | 10,964 | 1 |
| Farmville, NC | $31.08 | $24.63 – $33.06 | 10,958 | 4 |
| Cream Ridge, NJ | $18.41 | $12.44 – $45.93 | 10,953 | 3 |
| Haggerhill, KY | $30.18 | $30.18 – $30.18 | 10,951 | 1 |
| San Manuel, AZ | $86.99 | $55.29 – $92.00 | 10,941 | 4 |
| Choteau, MT | $53.04 | $0.00 – $114.86 | 10,940 | 5 |
| Spiro, OK | $109.45 | $62.51 – $393.51 | 10,939 | 5 |
| Weatogue, CT | $39.87 | $0.00 – $110.46 | 10,931 | 10 |
| Attica, OH | $112.10 | $112.10 – $112.10 | 10,925 | 1 |
| Herndon, PA | $40.03 | $36.35 – $41.51 | 10,913 | 3 |
| Bridgeville, DE | $61.85 | $0.00 – $80.86 | 10,911 | 6 |
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.