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 |
|---|---|---|---|---|
| Toksook Bay, AK | $510.33 | $0.00 – $629.37 | 9,032 | 10 |
| Bloomfield, MO | $52.10 | $45.31 – $58.26 | 9,032 | 4 |
| South Daytona, FL | $38.15 | $0.00 – $49.75 | 9,025 | 5 |
| East Ellijay, GA | $41.94 | $37.41 – $58.92 | 9,023 | 6 |
| Manti, UT | $69.01 | $38.27 – $83.55 | 9,017 | 8 |
| Midlothian, IL | $54.40 | $46.08 – $73.29 | 9,017 | 4 |
| Walkertown, NC | $65.51 | $38.87 – $73.57 | 9,015 | 6 |
| Saint Charles, MI | $66.64 | $12.27 – $68.48 | 9,013 | 3 |
| Quinhagak, AK | $173.09 | $0.00 – $280.24 | 9,005 | 4 |
| Conshohocken, PA | $40.18 | $13.23 – $86.88 | 9,004 | 11 |
| Dongola, IL | $0.00 | $0.00 – $0.00 | 9,000 | 1 |
| Manor, TX | $24.40 | $0.00 – $455.00 | 8,992 | 10 |
| Batesburg-Leesville, SC | $172.53 | $26.59 – $201.17 | 8,974 | 3 |
| Arcanum, OH | $21.26 | $4.24 – $25.08 | 8,970 | 4 |
| Westernport, MD | $128.66 | $0.00 – $268.15 | 8,964 | 11 |
| Saint Paul, VA | $48.26 | $34.82 – $62.94 | 8,946 | 4 |
| Lonetree, CO | $98.42 | $46.61 – $162.98 | 8,939 | 5 |
| Jackson Center, OH | $40.59 | $33.60 – $53.61 | 8,932 | 6 |
| Honeoye Falls, NY | $70.04 | $55.62 – $103.77 | 8,930 | 8 |
| Narragansett, RI | $80.20 | $44.46 – $131.51 | 8,924 | 8 |
| Adkins, TX | $42.99 | $40.58 – $48.46 | 8,923 | 2 |
| Runnemede, NJ | $76.61 | $0.68 – $145.96 | 8,920 | 6 |
| Comstock Park, MI | $66.55 | $66.55 – $66.55 | 8,918 | 1 |
| Pender, NE | $125.07 | $31.34 – $146.99 | 8,912 | 11 |
| Hawarden, IA | $7.34 | $0.05 – $35.48 | 8,911 | 5 |
| Toledo, IL | $46.23 | $11.72 – $50.50 | 8,910 | 2 |
| Washougal, WA | $65.71 | $39.66 – $88.66 | 8,907 | 6 |
| Republic, WA | $72.49 | $0.68 – $96.04 | 8,903 | 5 |
| Kokomo, MS | $16.49 | $8.20 – $43.44 | 8,902 | 3 |
| Hopedale, MA | $46.79 | $30.62 – $105.76 | 8,900 | 14 |
| Valatie, NY | $66.29 | $29.11 – $102.62 | 8,888 | 10 |
| Mifflinburg, PA | $43.98 | $14.33 – $63.91 | 8,887 | 5 |
| Sanborn, NY | $59.82 | $54.51 – $79.25 | 8,882 | 4 |
| Custer, SD | $40.46 | $0.00 – $69.93 | 8,880 | 7 |
| Whispering Pines, NC | $47.96 | $38.89 – $57.42 | 8,875 | 8 |
| Kwethluk, AK | $185.06 | $0.00 – $441.98 | 8,873 | 7 |
| Breckenridge, MI | $39.59 | $39.59 – $39.59 | 8,871 | 1 |
| S El Monte, CA | $6.18 | $0.21 – $42.43 | 8,865 | 2 |
| Charenton, LA | $0.04 | $0.04 – $0.04 | 8,859 | 1 |
| Wapato, WA | $59.21 | $2.50 – $328.77 | 8,858 | 7 |
| Old Bethpage, NY | $103.34 | $59.03 – $108.08 | 8,856 | 7 |
| Collinsville, AL | $44.34 | $0.00 – $75.53 | 8,854 | 4 |
| Wahoo, NE | $84.64 | $13.17 – $140.48 | 8,854 | 10 |
| Riverdale, NY | $101.86 | $53.07 – $117.41 | 8,851 | 3 |
| Kane, PA | $132.34 | $3.99 – $500.20 | 8,851 | 9 |
| Decatur, MS | $72.30 | $24.72 – $104.49 | 8,851 | 7 |
| Sneads Ferry, NC | $45.69 | $9.23 – $61.69 | 8,851 | 4 |
| Forrest, IL | $0.00 | $0.00 – $0.00 | 8,842 | 1 |
| Wilton, IA | $23.56 | $0.00 – $70.45 | 8,841 | 4 |
| Conway, NC | $33.63 | $29.61 – $41.42 | 8,836 | 2 |
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.