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 |
|---|---|---|---|---|
| Frankfort, MI | $40.82 | $17.44 – $68.05 | 9,211 | 4 |
| Lakeville, NY | $73.68 | $53.71 – $85.09 | 9,208 | 4 |
| Sterling Hghts, MI | $70.57 | $70.57 – $70.57 | 9,207 | 1 |
| Boonton, NJ | $46.39 | $0.00 – $75.73 | 9,204 | 11 |
| New Boston, MI | $80.32 | $39.71 – $81.75 | 9,204 | 3 |
| Kenilworth, NJ | $30.67 | $30.16 – $38.90 | 9,198 | 3 |
| Clarks Summit, PA | $43.44 | $0.00 – $85.66 | 9,192 | 11 |
| Sonora, KY | $32.05 | $30.63 – $33.17 | 9,190 | 2 |
| Mastic, NY | $49.80 | $49.66 – $77.92 | 9,187 | 2 |
| Burna, KY | $35.42 | $35.42 – $35.42 | 9,183 | 1 |
| Odessa, MO | $112.78 | $87.18 – $123.24 | 9,182 | 3 |
| Upper Tumon, GU | $80.20 | $67.50 – $99.94 | 9,179 | 4 |
| Johnstown, OH | $44.66 | $35.65 – $119.96 | 9,174 | 8 |
| Kiryas Joel, NY | $97.69 | $97.69 – $97.69 | 9,169 | 1 |
| Fordsville, KY | $38.98 | $9.15 – $50.40 | 9,165 | 3 |
| Irwinton, GA | $98.65 | $32.18 – $98.96 | 9,163 | 2 |
| Gilman, IL | $2.06 | $2.06 – $2.06 | 9,153 | 1 |
| Robbins, NC | $51.90 | $45.51 – $56.56 | 9,147 | 2 |
| Kentland, IN | $53.02 | $3.88 – $55.02 | 9,146 | 3 |
| Vinalhaven, ME | $62.28 | $24.80 – $83.10 | 9,144 | 3 |
| Galliano, LA | $0.00 | $0.00 – $0.00 | 9,141 | 2 |
| Dallas, GA | $96.25 | $3.03 – $757.83 | 9,140 | 9 |
| Macedonia, OH | $52.28 | $3.58 – $115.81 | 9,138 | 9 |
| Wilmington, IL | $53.08 | $41.44 – $56.68 | 9,137 | 4 |
| Gueydan, LA | $11.92 | $0.00 – $38.95 | 9,133 | 3 |
| Hiawassee, GA | $39.45 | $0.00 – $76.20 | 9,133 | 6 |
| Estancia, NM | $145.44 | $80.20 – $157.12 | 9,132 | 3 |
| Steeleville, IL | $0.07 | $0.06 – $0.07 | 9,129 | 2 |
| Owens Cross Roads, AL | $67.97 | $23.72 – $78.43 | 9,123 | 7 |
| Wilburton, OK | $97.96 | $21.35 – $614.17 | 9,118 | 5 |
| Berrien Springs, MI | $106.12 | $0.04 – $260.45 | 9,118 | 3 |
| Moss Beach, CA | $3.16 | $3.06 – $76.28 | 9,108 | 2 |
| Canadian Lakes, MI | $8.59 | $8.59 – $8.59 | 9,094 | 1 |
| Wall Township, NJ | $45.21 | $1.03 – $116.27 | 9,094 | 19 |
| Grambling, LA | $0.00 | $0.00 – $0.00 | 9,089 | 2 |
| Lebanon, NJ | $67.22 | $5.04 – $95.12 | 9,087 | 6 |
| Trenton, ME | $120.23 | $2.50 – $336.23 | 9,086 | 9 |
| Hatboro, PA | $45.19 | $13.38 – $51.89 | 9,085 | 11 |
| Red Lodge, MT | $86.95 | $0.00 – $102.73 | 9,071 | 10 |
| New Paris, PA | $5.67 | $0.00 – $39.72 | 9,068 | 9 |
| Kingsley, MI | $67.54 | $67.54 – $67.54 | 9,063 | 1 |
| Quartzsite, AZ | $0.45 | $0.26 – $37.78 | 9,061 | 2 |
| Verona, WI | $38.82 | $2.47 – $80.39 | 9,060 | 22 |
| Baxter, TN | $32.60 | $26.08 – $35.25 | 9,054 | 4 |
| Scott City, KS | $247.42 | $25.83 – $263.78 | 9,052 | 5 |
| Shirley, MA | $38.75 | $34.38 – $39.32 | 9,041 | 2 |
| Lutherville Timonium, MD | $112.91 | $34.20 – $238.16 | 9,038 | 19 |
| Akron, IA | $36.95 | $0.09 – $53.29 | 9,036 | 3 |
| Dixon, MO | $20.93 | $20.54 – $27.16 | 9,034 | 2 |
| Fife, WA | $46.32 | $26.88 – $68.61 | 9,032 | 7 |
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.