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 |
|---|---|---|---|---|
| Sedona, AZ | $43.72 | $11.84 – $103.47 | 10,333 | 22 |
| Metarie, LA | $20.33 | $7.44 – $65.93 | 10,330 | 2 |
| Burtonsville, MD | $77.52 | $30.82 – $124.70 | 10,316 | 12 |
| Centerburg, OH | $42.22 | $36.10 – $45.45 | 10,316 | 3 |
| Brookpark, OH | $33.66 | $22.33 – $81.92 | 10,314 | 9 |
| Dixon, KY | $33.24 | $29.25 – $60.29 | 10,314 | 6 |
| Woodlawn, MD | $85.63 | $79.20 – $135.61 | 10,313 | 4 |
| South Lyon, MI | $59.85 | $42.52 – $71.17 | 10,311 | 7 |
| Gainesville, MO | $68.01 | $16.75 – $83.69 | 10,310 | 6 |
| Tubac, AZ | $0.04 | $0.04 – $0.04 | 10,307 | 1 |
| Milan, OH | $39.09 | $33.01 – $55.65 | 10,304 | 5 |
| Hamilton, MS | $66.42 | $28.99 – $92.38 | 10,303 | 7 |
| Boonton Township, NJ | $78.15 | $78.15 – $78.15 | 10,288 | 1 |
| Seward, AK | $119.18 | $0.00 – $710.00 | 10,288 | 11 |
| Moyock, NC | $46.92 | $19.76 – $55.71 | 10,278 | 7 |
| Shadyside, OH | $44.72 | $35.60 – $48.13 | 10,275 | 2 |
| Phillips, WI | $39.92 | $11.00 – $66.70 | 10,273 | 11 |
| Jones, OK | $93.50 | $93.50 – $93.50 | 10,273 | 1 |
| Amanda, OH | $43.31 | $40.84 – $49.16 | 10,263 | 4 |
| Junction City, OR | $32.96 | $13.29 – $80.28 | 10,262 | 7 |
| New Augusta, MS | $117.88 | $30.56 – $135.06 | 10,259 | 6 |
| University City, MO | $57.92 | $47.82 – $84.18 | 10,256 | 4 |
| Coats, NC | $47.16 | $15.81 – $61.53 | 10,250 | 9 |
| Macedon, NY | $64.83 | $7.05 – $86.25 | 10,247 | 8 |
| Cullowhee, NC | $256.74 | $32.76 – $664.04 | 10,246 | 6 |
| Sylacouga, AL | $53.53 | $53.53 – $53.53 | 10,243 | 1 |
| Mc Donald, TN | $35.23 | $17.75 – $42.42 | 10,241 | 3 |
| Goffstown, NH | $50.02 | $9.90 – $54.87 | 10,240 | 7 |
| Manteno, IL | $56.68 | $36.75 – $64.10 | 10,226 | 7 |
| Mansfield, MO | $65.72 | $59.72 – $75.86 | 10,226 | 3 |
| Momence, IL | $59.86 | $45.99 – $157.16 | 10,225 | 3 |
| Yuma, CO | $160.56 | $125.34 – $285.88 | 10,223 | 8 |
| Nortonville, KY | $38.47 | $37.21 – $39.55 | 10,214 | 3 |
| Tobyhanna, PA | $44.39 | $30.68 – $51.57 | 10,213 | 4 |
| Cedaredge, CO | $52.52 | $48.50 – $66.42 | 10,212 | 5 |
| Redfield, SD | $71.85 | $68.94 – $111.82 | 10,200 | 2 |
| Blackstone, VA | $45.46 | $35.71 – $69.03 | 10,199 | 6 |
| East Prairie, MO | $28.76 | $23.50 – $42.87 | 10,196 | 3 |
| Graham, NC | $85.08 | $24.16 – $168.86 | 10,194 | 12 |
| Wild Rose, WI | $36.25 | $25.25 – $205.11 | 10,193 | 10 |
| Myrtle Point, OR | $39.30 | $6.85 – $78.39 | 10,192 | 4 |
| Piggott, AR | $68.61 | $31.12 – $88.77 | 10,192 | 3 |
| West Mifflin, PA | $55.49 | $0.00 – $72.60 | 10,191 | 27 |
| East Palestine, OH | $38.81 | $33.14 – $43.09 | 10,182 | 6 |
| Aniak, AK | $189.50 | $0.00 – $430.03 | 10,176 | 4 |
| Springfield Gardens, NY | $50.42 | $3.55 – $136.64 | 10,175 | 11 |
| North Branch, MN | $91.11 | $10.14 – $131.71 | 10,174 | 16 |
| Bark River, MI | $67.55 | $67.55 – $67.55 | 10,173 | 1 |
| Smith Center, KS | $165.84 | $13.39 – $166.48 | 10,171 | 3 |
| Naches, WA | $29.05 | $0.53 – $50.73 | 10,162 | 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.