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 |
|---|---|---|---|---|
| Boqueron, PR | $0.08 | $0.00 – $0.64 | 9,388 | 2 |
| Popano Beach, FL | $50.41 | $50.41 – $50.41 | 9,385 | 1 |
| Follansbee, WV | $59.88 | $27.69 – $78.93 | 9,383 | 5 |
| Locust Grove, OK | $66.62 | $66.49 – $66.77 | 9,381 | 2 |
| Concordia, KS | $142.33 | $0.30 – $155.47 | 9,381 | 9 |
| Fort Oglethorpe, GA | $45.07 | $0.00 – $60.81 | 9,381 | 8 |
| Pilot Point, TX | $59.62 | $24.38 – $74.91 | 9,380 | 3 |
| Birch Run, MI | $55.33 | $42.64 – $56.26 | 9,379 | 5 |
| Cecil, PA | $63.29 | $33.12 – $71.78 | 9,377 | 3 |
| Hebron, CT | $35.59 | $0.00 – $66.58 | 9,375 | 6 |
| Monroe City, MO | $61.68 | $46.01 – $98.00 | 9,360 | 5 |
| Pleasant Hill, OR | $62.71 | $4.28 – $77.12 | 9,353 | 6 |
| Wayland, KY | $34.40 | $33.27 – $35.32 | 9,344 | 2 |
| Irvington, NY | $89.30 | $53.41 – $123.99 | 9,343 | 4 |
| Cold Spring, KY | $53.69 | $22.83 – $59.89 | 9,338 | 14 |
| Cohocton, NY | $63.19 | $55.68 – $66.04 | 9,324 | 3 |
| La Grange, NC | $43.35 | $39.49 – $55.33 | 9,323 | 3 |
| Crescent, IA | $47.79 | $47.79 – $47.79 | 9,320 | 1 |
| Spanish Fort, AL | $52.45 | $0.00 – $107.81 | 9,320 | 9 |
| Long Beach, WA | $90.62 | $0.67 – $186.39 | 9,318 | 7 |
| Douglas, WY | $46.42 | $6.77 – $92.49 | 9,315 | 14 |
| Hoxie, AR | $28.76 | $28.76 – $28.76 | 9,314 | 1 |
| Warminster, PA | $35.04 | $0.00 – $77.58 | 9,308 | 23 |
| Beale Afb, CA | $7.19 | $0.29 – $57.37 | 9,305 | 4 |
| Varney, WV | $69.05 | $69.05 – $69.05 | 9,301 | 1 |
| Ridgeland, SC | $115.14 | $35.13 – $212.60 | 9,297 | 12 |
| West River, MD | $67.46 | $0.00 – $102.29 | 9,296 | 7 |
| Holland, PA | $40.83 | $24.61 – $52.94 | 9,295 | 4 |
| Saint Henry, OH | $42.68 | $27.47 – $55.07 | 9,294 | 5 |
| Mulberry, FL | $29.56 | $17.56 – $40.34 | 9,293 | 7 |
| Mercedes, TX | $23.09 | $0.00 – $34.82 | 9,290 | 6 |
| Pearl River, NY | $63.49 | $11.94 – $111.26 | 9,284 | 12 |
| Bristow, IN | $57.50 | $53.98 – $58.97 | 9,284 | 2 |
| Little Ferry, NJ | $59.74 | $11.36 – $78.69 | 9,278 | 4 |
| Dewitt, MI | $57.55 | $41.23 – $61.75 | 9,277 | 5 |
| Gamaliel, KY | $28.02 | $22.53 – $28.80 | 9,268 | 2 |
| Bellefonte, PA | $39.69 | $35.23 – $77.45 | 9,266 | 9 |
| Kitts Hill, OH | $25.28 | $0.42 – $34.42 | 9,260 | 3 |
| Fredericksbrg, VA | $57.04 | $43.13 – $72.12 | 9,258 | 5 |
| St Albans, VT | $23.63 | $7.06 – $52.52 | 9,258 | 9 |
| Ecru, MS | $38.65 | $0.00 – $74.98 | 9,255 | 10 |
| Tieton, WA | $40.33 | $39.69 – $65.64 | 9,254 | 3 |
| Grosse Pointe, MI | $62.58 | $14.64 – $99.33 | 9,253 | 14 |
| Lexington, GA | $60.88 | $15.57 – $106.19 | 9,251 | 5 |
| Alberta, VA | $47.64 | $26.75 – $54.57 | 9,242 | 4 |
| Socorro, TX | $35.50 | $35.24 – $38.02 | 9,241 | 3 |
| West Franklin, NH | $70.49 | $50.92 – $273.99 | 9,228 | 3 |
| Middlebury, IN | $51.84 | $33.22 – $75.06 | 9,221 | 8 |
| Collingswood, NJ | $44.88 | $5.89 – $165.68 | 9,220 | 10 |
| Benton, MO | $63.46 | $18.11 – $158.83 | 9,219 | 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.