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 |
|---|---|---|---|---|
| Shelburne Falls, MA | $50.30 | $33.24 – $60.18 | 10,718 | 4 |
| Newport, PA | $45.61 | $34.66 – $80.91 | 10,712 | 9 |
| Schuyler, NE | $112.70 | $38.00 – $239.61 | 10,711 | 9 |
| Camby, IN | $39.23 | $24.96 – $100.55 | 10,707 | 8 |
| Logan, IA | $0.29 | $0.14 – $49.50 | 10,703 | 2 |
| Stanley, VA | $62.59 | $59.95 – $72.18 | 10,702 | 4 |
| Chandler, OK | $76.60 | $0.00 – $120.71 | 10,701 | 8 |
| Audubon, IA | $14.41 | $0.15 – $61.88 | 10,699 | 12 |
| Stony Creek, VA | $39.90 | $9.61 – $49.89 | 10,698 | 3 |
| Muskego, WI | $33.90 | $11.93 – $62.22 | 10,695 | 19 |
| Prescott, MI | $22.49 | $15.52 – $60.56 | 10,691 | 3 |
| Archbold, OH | $50.21 | $32.94 – $66.19 | 10,691 | 7 |
| Morrilton, AR | $36.81 | $17.35 – $59.47 | 10,689 | 10 |
| Solana Beach, CA | $7.37 | $0.00 – $47.58 | 10,688 | 10 |
| Potts Camp, MS | $51.49 | $9.65 – $53.80 | 10,679 | 4 |
| Wenonah, NJ | $65.86 | $52.59 – $126.50 | 10,678 | 10 |
| St.Clairsville, OH | $42.40 | $42.40 – $42.40 | 10,677 | 1 |
| Belle Plaine, IA | $0.36 | $0.00 – $32.57 | 10,675 | 4 |
| Madrid, IA | $26.66 | $0.79 – $32.39 | 10,673 | 5 |
| Manila, AR | $32.72 | $3.75 – $37.98 | 10,670 | 11 |
| Cleveland Hts, OH | $47.95 | $35.56 – $56.73 | 10,667 | 3 |
| Kimberly, ID | $8.90 | $0.97 – $55.71 | 10,666 | 4 |
| Strasburg, CO | $174.83 | $78.36 – $224.51 | 10,665 | 4 |
| Glasgow, VA | $56.94 | $21.98 – $101.61 | 10,664 | 6 |
| Dumas, AR | $20.89 | $0.00 – $58.00 | 10,659 | 6 |
| Dedham, NY | $85.66 | $85.66 – $85.66 | 10,658 | 1 |
| La Conner, WA | $28.88 | $0.00 – $41.59 | 10,654 | 6 |
| Church Hill, TN | $41.73 | $21.88 – $86.17 | 10,640 | 6 |
| Lebanon, CT | $78.93 | $24.85 – $91.59 | 10,640 | 2 |
| Kenbridge, VA | $51.76 | $51.76 – $51.76 | 10,635 | 1 |
| New Paris, IN | $50.13 | $48.70 – $66.03 | 10,634 | 3 |
| Ft Mitchell, AL | $5.99 | $5.99 – $5.99 | 10,634 | 1 |
| Mc Leansboro, IL | $19.90 | $0.00 – $130.77 | 10,627 | 4 |
| Locust Grove, VA | $70.37 | $47.86 – $86.38 | 10,610 | 6 |
| Union City, PA | $25.74 | $0.00 – $45.35 | 10,595 | 8 |
| Winthrop, MA | $36.21 | $16.31 – $64.94 | 10,587 | 9 |
| Charleston, MO | $82.53 | $15.47 – $248.56 | 10,578 | 9 |
| Pacific Palisades, CA | $14.24 | $0.00 – $100.48 | 10,562 | 12 |
| Kilgore, TX | $45.01 | $6.80 – $75.87 | 10,560 | 12 |
| Higganum, CT | $49.87 | $18.50 – $66.16 | 10,560 | 8 |
| Fort Benton, MT | $0.87 | $0.00 – $48.96 | 10,560 | 5 |
| Mcintosh, AL | $10.09 | $0.00 – $21.42 | 10,556 | 3 |
| Cooper City, FL | $112.86 | $2.72 – $497.75 | 10,555 | 8 |
| West Roxbury, MA | $40.10 | $1.23 – $128.78 | 10,553 | 27 |
| Questa, NM | $135.10 | $55.07 – $142.90 | 10,549 | 3 |
| Sigourney, IA | $20.70 | $0.04 – $115.24 | 10,539 | 9 |
| Post, TX | $15.52 | $0.00 – $43.86 | 10,534 | 4 |
| Afton, OK | $97.81 | $1.05 – $224.34 | 10,527 | 5 |
| Margaretville, NY | $81.52 | $64.34 – $116.71 | 10,517 | 7 |
| Tsaile, AZ | $104.61 | $11.31 – $114.18 | 10,517 | 5 |
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.