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 |
|---|---|---|---|---|
| Point Pleasant Boro, NJ | $54.15 | $37.45 – $78.19 | 9,991 | 5 |
| Springvalley, NY | $11.86 | $11.86 – $11.86 | 9,989 | 1 |
| Leola, PA | $52.06 | $27.12 – $61.14 | 9,982 | 11 |
| Margate City, NJ | $44.72 | $23.62 – $90.06 | 9,977 | 8 |
| Eagle River, WI | $34.38 | $20.88 – $49.86 | 9,976 | 8 |
| Paintsvile, KY | $23.85 | $23.85 – $23.85 | 9,973 | 1 |
| Eagle Rock, CA | $5.90 | $2.26 – $64.32 | 9,966 | 4 |
| Mahanoy City, PA | $42.72 | $15.61 – $59.86 | 9,960 | 5 |
| Chadron, NE | $57.36 | $16.48 – $128.52 | 9,960 | 15 |
| Mardela Springs, MD | $96.69 | $96.69 – $96.69 | 9,953 | 1 |
| Pineville, NC | $24.87 | $0.00 – $99.66 | 9,947 | 21 |
| Eureka Springs, AR | $32.48 | $21.61 – $37.62 | 9,943 | 12 |
| Crescent Springs, KY | $55.36 | $39.09 – $61.04 | 9,938 | 3 |
| Myerstown, PA | $45.32 | $39.48 – $62.34 | 9,936 | 6 |
| Slc, UT | $125.18 | $0.03 – $705.17 | 9,935 | 25 |
| Clayton, MO | $27.81 | $10.95 – $90.53 | 9,935 | 7 |
| Bingham, ME | $0.87 | $0.33 – $7.19 | 9,927 | 2 |
| Osceola, WI | $41.22 | $8.81 – $66.88 | 9,926 | 16 |
| Hennessey, OK | $73.20 | $69.87 – $80.12 | 9,911 | 3 |
| Ellsworth, KS | $123.56 | $13.98 – $124.74 | 9,911 | 5 |
| Seabrook, NH | $43.97 | $11.54 – $70.63 | 9,908 | 5 |
| Barneveld, NY | $80.56 | $37.95 – $99.00 | 9,903 | 11 |
| Colby, WI | $36.48 | $14.64 – $65.27 | 9,896 | 11 |
| Boyle, MS | $57.21 | $56.28 – $92.42 | 9,894 | 2 |
| Bogue Chitto, MS | $35.63 | $35.53 – $36.51 | 9,894 | 2 |
| Bowling Green, VA | $54.09 | $25.99 – $75.39 | 9,893 | 9 |
| Lagrange, OH | $23.49 | $0.38 – $27.46 | 9,885 | 2 |
| Ponte Vedra Beach, FL | $37.55 | $2.33 – $115.02 | 9,882 | 19 |
| Norridge, IL | $56.62 | $21.25 – $83.62 | 9,875 | 8 |
| Beverly, KY | $35.44 | $35.32 – $38.07 | 9,857 | 2 |
| Smiths Grove, KY | $40.54 | $13.81 – $46.42 | 9,851 | 6 |
| Hilton Head Island, SC | $64.25 | $19.34 – $71.78 | 9,844 | 12 |
| Henry, TN | $38.18 | $37.59 – $39.12 | 9,843 | 2 |
| Shelburn, IN | $48.24 | $36.86 – $48.97 | 9,841 | 2 |
| Black Mountain, NC | $55.19 | $19.43 – $73.06 | 9,831 | 16 |
| Somers, CT | $35.81 | $20.40 – $68.00 | 9,829 | 5 |
| Buckley, MI | $4.76 | $4.76 – $4.76 | 9,827 | 1 |
| East Windsor, CT | $43.85 | $42.65 – $59.60 | 9,826 | 3 |
| Cheltenham, PA | $45.68 | $24.20 – $46.72 | 9,821 | 2 |
| Pelican Rapids, MN | $68.49 | $40.01 – $101.56 | 9,821 | 7 |
| W Babylon, NY | $72.42 | $72.42 – $72.42 | 9,818 | 1 |
| Lakehurst, NJ | $46.25 | $0.00 – $47.90 | 9,817 | 3 |
| Vansant, VA | $45.18 | $28.63 – $55.33 | 9,815 | 5 |
| Fort Washington, PA | $30.12 | $3.99 – $121.63 | 9,815 | 15 |
| Fayette, MO | $56.69 | $16.63 – $150.54 | 9,807 | 10 |
| Mora, NM | $107.48 | $41.83 – $153.84 | 9,801 | 4 |
| Bellbrook, OH | $49.43 | $27.03 – $60.11 | 9,792 | 6 |
| Waimea, HI | $106.15 | $58.64 – $158.73 | 9,780 | 9 |
| Lumberton, MS | $102.20 | $27.33 – $128.79 | 9,780 | 4 |
| Irving, NY | $88.36 | $33.89 – $703.61 | 9,778 | 13 |
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.