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 |
|---|---|---|---|---|
| Farmington, AR | $36.04 | $0.00 – $48.29 | 8,503 | 10 |
| Annandale, NJ | $69.01 | $21.96 – $80.38 | 8,503 | 3 |
| Tyrone, PA | $32.83 | $0.36 – $58.80 | 8,500 | 11 |
| Ellington, MO | $75.28 | $47.28 – $120.02 | 8,497 | 5 |
| Woodbury Heights, NJ | $51.59 | $5.33 – $95.20 | 8,488 | 10 |
| Whiting, NJ | $38.77 | $2.35 – $70.89 | 8,477 | 11 |
| Frankewing, TN | $46.89 | $46.89 – $46.89 | 8,475 | 1 |
| Cupertino, CA | $28.84 | $0.00 – $107.92 | 8,473 | 19 |
| Milroy, IN | $73.05 | $51.54 – $77.91 | 8,469 | 3 |
| Cherokee, AL | $49.41 | $4.02 – $59.24 | 8,465 | 4 |
| Forty Fort, PA | $46.07 | $0.00 – $132.50 | 8,458 | 7 |
| Mansura, LA | $0.87 | $0.00 – $8.01 | 8,457 | 6 |
| Mount Washington, KY | $33.55 | $20.84 – $44.75 | 8,449 | 7 |
| Capac, MI | $55.70 | $54.34 – $56.84 | 8,444 | 3 |
| Kenmare, ND | $72.95 | $62.88 – $82.36 | 8,443 | 3 |
| Kewaunee, WI | $36.71 | $18.69 – $69.90 | 8,429 | 11 |
| Flandreau, SD | $289.53 | $84.42 – $474.85 | 8,423 | 2 |
| Lena, WI | $54.50 | $54.45 – $59.35 | 8,423 | 2 |
| Orono, ME | $51.47 | $19.59 – $114.42 | 8,420 | 12 |
| Ninety Six, SC | $62.67 | $44.67 – $72.45 | 8,417 | 5 |
| Dallastown, PA | $56.89 | $27.39 – $108.04 | 8,411 | 8 |
| Mountain View, MO | $68.61 | $35.32 – $318.75 | 8,407 | 9 |
| Newport, DE | $48.07 | $48.07 – $48.07 | 8,407 | 1 |
| Elmwood, IL | $27.62 | $0.41 – $64.45 | 8,401 | 6 |
| Middleton, ID | $52.63 | $0.00 – $63.15 | 8,394 | 10 |
| Saucier, MS | $57.51 | $23.91 – $103.71 | 8,394 | 5 |
| Forsyth, IL | $51.38 | $24.13 – $146.81 | 8,390 | 17 |
| Belle Haven, VA | $54.32 | $54.14 – $70.40 | 8,384 | 3 |
| Marcellus, NY | $82.56 | $76.36 – $84.10 | 8,380 | 2 |
| Lakeview, OR | $31.90 | $12.21 – $67.54 | 8,378 | 8 |
| Lansing, KS | $24.69 | $1.60 – $58.93 | 8,377 | 12 |
| Mammoth Spring, AR | $49.12 | $34.50 – $68.11 | 8,376 | 3 |
| Mount Vernon, AL | $0.00 | $0.00 – $0.00 | 8,375 | 2 |
| Flowery Branch, GA | $57.81 | $40.62 – $76.98 | 8,371 | 6 |
| Sweetwater, FL | $36.74 | $17.49 – $39.64 | 8,361 | 3 |
| Darlington, WI | $70.78 | $10.96 – $135.94 | 8,356 | 16 |
| Crossett, AR | $29.86 | $19.48 – $58.97 | 8,355 | 10 |
| Port Washington, NY | $68.04 | $2.69 – $195.48 | 8,355 | 15 |
| New Haven, KY | $28.23 | $23.16 – $33.73 | 8,355 | 2 |
| East Berlin, PA | $54.82 | $22.54 – $97.01 | 8,351 | 10 |
| Bimble, KY | $29.33 | $19.41 – $29.41 | 8,343 | 2 |
| Ft. Sill, OK | $0.39 | $0.04 – $0.42 | 8,338 | 2 |
| Ashville, OH | $41.76 | $33.39 – $67.37 | 8,337 | 6 |
| Danforth, ME | $3.63 | $3.63 – $3.63 | 8,337 | 1 |
| Aptos, CA | $3.85 | $0.00 – $82.47 | 8,336 | 17 |
| Crivitz, WI | $40.59 | $29.67 – $69.28 | 8,330 | 6 |
| Pecos, TX | $37.00 | $0.00 – $45.98 | 8,329 | 9 |
| India Harbor Bch, FL | $68.52 | $68.52 – $68.52 | 8,317 | 1 |
| Bedford, KY | $43.23 | $10.06 – $326.11 | 8,316 | 5 |
| Rose Hill, NC | $14.75 | $0.00 – $28.24 | 8,313 | 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.