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 |
|---|---|---|---|---|
| Manton, MI | $61.09 | $61.09 – $61.09 | 10,910 | 1 |
| Lenox, MA | $38.09 | $3.15 – $104.80 | 10,909 | 17 |
| Tiverton, RI | $71.26 | $34.50 – $119.56 | 10,909 | 13 |
| Hyde Park, UT | $37.74 | $1.24 – $122.73 | 10,905 | 11 |
| Montpelier, VA | $39.57 | $28.81 – $63.83 | 10,904 | 3 |
| Skaneateles, NY | $60.79 | $57.73 – $101.21 | 10,898 | 10 |
| Belden, MS | $60.88 | $9.70 – $71.80 | 10,896 | 5 |
| Gilbertown, AL | $12.00 | $4.17 – $72.90 | 10,896 | 3 |
| Berryville, AR | $33.22 | $8.20 – $54.96 | 10,895 | 16 |
| Ivel, KY | $28.91 | $28.91 – $28.91 | 10,895 | 1 |
| Brush, CO | $84.67 | $38.10 – $143.13 | 10,892 | 14 |
| Blakeslee, PA | $37.07 | $23.69 – $40.75 | 10,890 | 4 |
| Fyffe, AL | $11.36 | $0.00 – $52.55 | 10,887 | 2 |
| Addison, TX | $45.50 | $12.90 – $114.69 | 10,871 | 9 |
| Hilton, NY | $76.27 | $55.81 – $101.33 | 10,868 | 10 |
| Sanjuan, PR | $7.86 | $6.89 – $41.57 | 10,867 | 2 |
| Parkland, FL | $76.58 | $0.13 – $148.91 | 10,866 | 14 |
| Mexico, NY | $111.21 | $101.14 – $112.05 | 10,865 | 4 |
| Goldsboro, MD | $150.00 | $126.50 – $164.38 | 10,862 | 4 |
| Quarryville, PA | $70.26 | $43.21 – $113.71 | 10,858 | 6 |
| Hurley, MS | $131.45 | $50.29 – $178.87 | 10,851 | 4 |
| Lewisville, NC | $62.76 | $12.77 – $88.56 | 10,842 | 13 |
| Kellogg, ID | $13.30 | $0.00 – $35.49 | 10,840 | 7 |
| Perry, NY | $73.56 | $38.23 – $104.31 | 10,840 | 9 |
| Ilion, NY | $72.42 | $53.50 – $115.54 | 10,837 | 7 |
| Baden, PA | $35.74 | $25.54 – $36.07 | 10,833 | 3 |
| White Stone, VA | $55.66 | $45.56 – $59.44 | 10,830 | 7 |
| Casey, IL | $54.63 | $53.65 – $57.47 | 10,830 | 2 |
| Fulshear, TX | $37.23 | $31.33 – $129.93 | 10,830 | 10 |
| Wesson, MS | $25.41 | $0.09 – $85.93 | 10,824 | 4 |
| Kearny, AZ | $22.37 | $0.05 – $96.42 | 10,819 | 2 |
| Lewiston, MI | $16.64 | $16.64 – $16.64 | 10,815 | 1 |
| Sandy Hook, CT | $65.93 | $52.58 – $78.01 | 10,809 | 3 |
| Jackson, WY | $61.40 | $3.68 – $97.44 | 10,806 | 25 |
| De Witt, NY | $64.04 | $45.82 – $73.99 | 10,800 | 8 |
| Butler, GA | $103.01 | $103.01 – $103.01 | 10,795 | 1 |
| Shepherdstown, WV | $20.27 | $0.20 – $73.35 | 10,788 | 4 |
| Fortville, IN | $69.23 | $58.86 – $73.57 | 10,786 | 6 |
| Spring Hope, NC | $55.25 | $48.97 – $58.18 | 10,780 | 4 |
| Oyster Bay, NY | $57.75 | $6.47 – $100.71 | 10,776 | 5 |
| Robbins, IL | $14.14 | $2.66 – $65.26 | 10,765 | 5 |
| Manito, IL | $4.12 | $0.69 – $52.97 | 10,759 | 2 |
| Pelahatchie, MS | $67.40 | $19.30 – $103.61 | 10,757 | 5 |
| Toluca Lake, CA | $39.63 | $1.42 – $70.77 | 10,746 | 15 |
| Sibley, LA | $19.92 | $19.73 – $20.16 | 10,745 | 2 |
| Millwood, WA | $63.17 | $63.17 – $63.17 | 10,744 | 1 |
| Newington, NH | $25.20 | $10.78 – $58.71 | 10,742 | 8 |
| Hooksett, NH | $39.16 | $24.98 – $125.56 | 10,732 | 18 |
| Canajoharie, NY | $44.65 | $33.72 – $72.64 | 10,731 | 5 |
| Leupp, AZ | $522.51 | $508.78 – $526.23 | 10,727 | 2 |
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.