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 |
|---|---|---|---|---|
| Roma, TX | $23.56 | $0.00 – $34.60 | 10,161 | 5 |
| Vashon, WA | $44.33 | $0.00 – $66.84 | 10,161 | 18 |
| Berne, IN | $49.21 | $24.60 – $57.37 | 10,157 | 4 |
| Granville, NY | $70.38 | $42.68 – $94.85 | 10,155 | 6 |
| Lyons, KS | $164.95 | $28.23 – $179.30 | 10,151 | 8 |
| Orleans, IN | $49.54 | $44.16 – $64.80 | 10,148 | 4 |
| Sparks, MD | $146.92 | $20.96 – $187.59 | 10,144 | 3 |
| Egg Harbor City, NJ | $45.73 | $11.56 – $49.69 | 10,131 | 4 |
| Saint Peter, MN | $64.58 | $8.77 – $91.98 | 10,128 | 19 |
| Westminster, VT | $80.34 | $10.26 – $126.61 | 10,124 | 8 |
| Williamsport, IN | $59.52 | $40.60 – $74.44 | 10,113 | 7 |
| Northfork, WV | $16.35 | $16.35 – $16.35 | 10,109 | 1 |
| Dunkirk, IN | $56.82 | $56.82 – $56.82 | 10,104 | 1 |
| Albany, IN | $52.70 | $50.83 – $53.65 | 10,104 | 2 |
| Florence, MT | $81.54 | $70.92 – $113.16 | 10,099 | 8 |
| Troutdale, OR | $71.50 | $56.02 – $208.28 | 10,085 | 12 |
| Randolph, NY | $35.16 | $25.27 – $130.51 | 10,082 | 2 |
| Driggs, ID | $14.75 | $0.86 – $51.47 | 10,079 | 8 |
| Worth, IL | $61.50 | $17.10 – $78.56 | 10,078 | 8 |
| Newland, NC | $47.88 | $0.18 – $69.36 | 10,077 | 9 |
| Bieber, CA | $4.63 | $0.00 – $5.39 | 10,073 | 5 |
| Deer Park, TX | $56.35 | $0.00 – $130.24 | 10,069 | 11 |
| Golden, IL | $2.78 | $0.11 – $58.55 | 10,066 | 2 |
| Clinton, NJ | $69.11 | $15.11 – $109.99 | 10,064 | 9 |
| Phillipston, MA | $54.14 | $54.14 – $54.14 | 10,059 | 1 |
| Carthage, TX | $28.39 | $0.00 – $38.24 | 10,057 | 11 |
| Charleroi, PA | $43.19 | $14.76 – $54.43 | 10,056 | 10 |
| Danbury, NC | $41.20 | $29.05 – $54.57 | 10,055 | 3 |
| Circleville, NY | $105.61 | $102.29 – $126.82 | 10,050 | 3 |
| Lodi, OH | $51.37 | $39.33 – $84.98 | 10,048 | 8 |
| Aldie, VA | $79.82 | $20.11 – $111.89 | 10,046 | 14 |
| Lake Worth, TX | $44.07 | $29.03 – $58.90 | 10,045 | 4 |
| Bowling Green, MO | $60.77 | $15.70 – $103.92 | 10,043 | 20 |
| Lonoke, AR | $28.79 | $0.00 – $58.04 | 10,042 | 9 |
| Newkirk, OK | $40.99 | $0.80 – $79.08 | 10,041 | 5 |
| Big Bend, WI | $40.95 | $40.95 – $40.95 | 10,036 | 1 |
| Ocoee, TN | $37.74 | $36.31 – $45.41 | 10,027 | 5 |
| Tannersville, NY | $72.22 | $67.57 – $75.07 | 10,025 | 3 |
| Tooele, TN | $70.32 | $70.32 – $70.32 | 10,020 | 1 |
| Hedgesville, WV | $40.65 | $0.04 – $114.27 | 10,015 | 7 |
| Mount Jackson, VA | $51.37 | $37.09 – $62.23 | 10,015 | 6 |
| Mineville, NY | $67.19 | $65.92 – $69.93 | 10,012 | 2 |
| Southold, NY | $56.11 | $0.00 – $156.29 | 10,008 | 12 |
| North Huntingdon, PA | $46.63 | $12.51 – $90.25 | 10,006 | 25 |
| N Huntingdon, PA | $72.04 | $33.70 – $77.03 | 10,006 | 3 |
| Camden, NY | $70.96 | $66.65 – $82.03 | 10,005 | 5 |
| Merrionette Park, IL | $56.28 | $7.50 – $86.00 | 10,000 | 17 |
| Tulson, OK | $210.09 | $210.09 – $210.09 | 9,995 | 1 |
| Summerfield, FL | $31.36 | $0.00 – $50.86 | 9,994 | 16 |
| Darrington, WA | $53.08 | $18.77 – $62.83 | 9,993 | 4 |
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.