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 |
|---|---|---|---|---|
| Crooksville, OH | $39.39 | $34.67 – $60.54 | 7,825 | 5 |
| Wilton Manors, FL | $23.74 | $0.00 – $47.37 | 7,814 | 9 |
| Boonville, NY | $69.77 | $60.01 – $77.08 | 7,814 | 7 |
| Wellpinit, WA | $43.70 | $26.31 – $53.35 | 7,800 | 4 |
| Saint Gabriel, LA | $0.63 | $0.00 – $4.62 | 7,800 | 6 |
| San Carlos, AZ | $52.13 | $0.06 – $70.40 | 7,799 | 3 |
| Gatlinburg, TN | $33.55 | $2.66 – $46.72 | 7,793 | 3 |
| Tennille, GA | $74.75 | $42.94 – $126.73 | 7,789 | 4 |
| Foxborough, MA | $46.98 | $1.45 – $81.21 | 7,788 | 20 |
| Luxemburg, WI | $44.80 | $11.95 – $54.88 | 7,786 | 4 |
| Aurora, MN | $99.98 | $90.48 – $107.16 | 7,783 | 5 |
| Waveland, MS | $41.40 | $41.40 – $41.40 | 7,778 | 1 |
| Carey, OH | $27.80 | $17.19 – $39.21 | 7,772 | 3 |
| Aberdeen, NJ | $34.56 | $5.31 – $47.17 | 7,768 | 5 |
| Waterloo, SC | $149.41 | $148.99 – $159.49 | 7,764 | 3 |
| Mercer, PA | $12.65 | $0.00 – $34.16 | 7,759 | 8 |
| Cloverdale, IN | $53.15 | $50.68 – $56.02 | 7,751 | 3 |
| Chugiak, AK | $114.30 | $58.94 – $355.25 | 7,750 | 4 |
| Corning, AR | $43.91 | $0.00 – $54.92 | 7,744 | 10 |
| Sophia, NC | $72.48 | $72.48 – $72.48 | 7,744 | 1 |
| Masontown, PA | $69.34 | $59.72 – $69.50 | 7,741 | 2 |
| Flomaton, AL | $4.64 | $0.00 – $20.68 | 7,739 | 7 |
| Wetumka, OK | $12.61 | $0.00 – $53.55 | 7,735 | 7 |
| Montgomery City, MO | $102.13 | $16.38 – $110.02 | 7,734 | 5 |
| Roundup, MT | $0.00 | $0.00 – $0.00 | 7,727 | 1 |
| Braselton, GA | $53.92 | $11.69 – $143.56 | 7,726 | 20 |
| Needles, CA | $130.72 | $0.08 – $832.24 | 7,716 | 6 |
| Fries, VA | $39.49 | $18.28 – $61.42 | 7,714 | 4 |
| Winnebago, WI | $23.66 | $8.46 – $64.76 | 7,707 | 11 |
| Unionville, TN | $34.63 | $34.63 – $34.63 | 7,707 | 1 |
| Wayzata, MN | $74.71 | $6.74 – $183.48 | 7,697 | 17 |
| Callao, VA | $56.42 | $39.94 – $70.48 | 7,691 | 5 |
| Syracuse, NE | $74.00 | $42.69 – $170.57 | 7,686 | 7 |
| Los Altos Hills, CA | $88.63 | $26.41 – $163.33 | 7,684 | 8 |
| Warren, IN | $76.04 | $49.86 – $97.99 | 7,681 | 4 |
| Toronto, OH | $35.59 | $27.88 – $38.17 | 7,678 | 6 |
| Branson West, MO | $98.09 | $24.86 – $125.97 | 7,671 | 8 |
| Savanna, IL | $49.58 | $49.58 – $49.58 | 7,668 | 1 |
| Wilder, ID | $73.85 | $55.16 – $98.18 | 7,667 | 5 |
| Connell, WA | $23.48 | $7.77 – $33.05 | 7,667 | 3 |
| Pleasant Garden, NC | $46.39 | $40.74 – $70.59 | 7,666 | 2 |
| Monroe, UT | $59.69 | $44.64 – $67.10 | 7,653 | 3 |
| Holly Springs, GA | $60.71 | $21.58 – $77.45 | 7,643 | 7 |
| Hillsboro, TX | $47.27 | $18.46 – $82.88 | 7,641 | 5 |
| Ipswich, MA | $51.82 | $1.19 – $61.30 | 7,638 | 10 |
| Maxwell Afb, AL | $34.73 | $0.00 – $60.37 | 7,636 | 4 |
| West Jefferson, OH | $47.28 | $33.54 – $83.35 | 7,632 | 5 |
| Belmont, CA | $13.46 | $0.00 – $89.88 | 7,619 | 8 |
| Broken Bow, NE | $62.36 | $14.17 – $69.60 | 7,610 | 9 |
| Little Elm, TX | $65.99 | $2.20 – $85.11 | 7,608 | 12 |
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.