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 |
|---|---|---|---|---|
| Westley, CA | $3.41 | $0.00 – $3.44 | 8,131 | 2 |
| Calera, AL | $159.27 | $0.00 – $546.43 | 8,130 | 12 |
| Lake View, IA | $0.77 | $0.01 – $16.75 | 8,129 | 3 |
| Ludlow, VT | $0.61 | $0.00 – $39.09 | 8,127 | 5 |
| South Berwick, ME | $39.32 | $20.76 – $61.17 | 8,124 | 12 |
| Middleburg Hts, OH | $40.79 | $27.60 – $55.32 | 8,120 | 6 |
| Rock Rapids, IA | $73.22 | $1.66 – $577.25 | 8,118 | 10 |
| Levittown, PR | $1.94 | $0.50 – $68.07 | 8,115 | 5 |
| Jonesboro, GA | $64.00 | $0.00 – $227.08 | 8,115 | 20 |
| Healdton, OK | $73.75 | $30.88 – $74.28 | 8,115 | 2 |
| Holly Hill, SC | $177.33 | $38.53 – $188.28 | 8,113 | 4 |
| Douglassville, PA | $51.68 | $17.59 – $88.20 | 8,113 | 14 |
| Marshall, VA | $85.70 | $29.15 – $85.82 | 8,112 | 2 |
| Robertsdale, AL | $118.01 | $0.00 – $220.79 | 8,111 | 8 |
| Rowlett, TX | $27.33 | $0.86 – $93.36 | 8,109 | 20 |
| Mckenzie, TN | $40.68 | $40.68 – $40.68 | 8,108 | 1 |
| Sandy Springs, GA | $51.26 | $15.86 – $184.30 | 8,107 | 16 |
| Hopedale, IL | $42.28 | $8.04 – $52.26 | 8,106 | 6 |
| Belleville, MI | $56.88 | $18.48 – $97.27 | 8,106 | 5 |
| San Germain, PR | $0.97 | $0.97 – $0.97 | 8,092 | 1 |
| Mount Holly, NC | $52.27 | $37.05 – $102.08 | 8,091 | 13 |
| Wade, NC | $71.92 | $0.00 – $125.28 | 8,084 | 6 |
| Rush, KY | $28.54 | $23.89 – $29.73 | 8,079 | 3 |
| North Grosvenordale, CT | $71.86 | $71.86 – $71.86 | 8,076 | 1 |
| De Kalb, TX | $34.02 | $15.07 – $34.28 | 8,073 | 3 |
| Leopold, IN | $41.51 | $41.51 – $41.51 | 8,071 | 1 |
| Belle Fourche, SD | $84.88 | $9.31 – $95.16 | 8,067 | 5 |
| Scottdale, PA | $47.61 | $30.62 – $68.82 | 8,065 | 7 |
| Bonsall, CA | $0.39 | $0.38 – $1.59 | 8,059 | 2 |
| Poultney, VT | $83.63 | $83.63 – $83.63 | 8,058 | 1 |
| East Rutherford, NJ | $50.01 | $23.50 – $97.81 | 8,053 | 5 |
| Jarvisburg, NC | $41.24 | $41.24 – $41.24 | 8,051 | 1 |
| Terra Bella, CA | $12.82 | $12.82 – $12.82 | 8,044 | 1 |
| Ely, MN | $147.08 | $74.28 – $180.05 | 8,039 | 8 |
| Mouthcard, KY | $35.67 | $35.67 – $35.67 | 8,035 | 1 |
| Lake Andes, SD | $96.27 | $41.84 – $96.36 | 8,028 | 2 |
| Mechanicsville, MD | $100.79 | $28.00 – $144.61 | 8,028 | 9 |
| Seward, NE | $84.75 | $13.96 – $163.18 | 8,024 | 14 |
| Pinecrest, FL | $14.44 | $6.70 – $80.19 | 8,024 | 12 |
| Lockhart, TX | $64.72 | $13.33 – $204.86 | 8,023 | 9 |
| Blaine, WA | $66.82 | $2.69 – $328.44 | 8,020 | 9 |
| Edwardsburg, MI | $53.43 | $31.76 – $90.20 | 8,019 | 6 |
| Lake Zurich, IL | $56.06 | $31.52 – $106.40 | 8,019 | 16 |
| Clearfield, UT | $63.35 | $30.90 – $63.65 | 8,010 | 2 |
| Harrington Park, NJ | $39.26 | $3.18 – $57.91 | 8,005 | 12 |
| Anderson, MO | $95.99 | $59.17 – $155.77 | 8,001 | 8 |
| Bridgeport, NE | $110.26 | $13.40 – $276.30 | 8,001 | 8 |
| Lower Brule, SD | $489.99 | $396.80 – $528.35 | 7,996 | 2 |
| Buchanan, VA | $56.48 | $55.89 – $67.85 | 7,991 | 2 |
| Woodstock, NY | $83.32 | $39.12 – $132.45 | 7,991 | 9 |
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.