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 |
|---|---|---|---|---|
| North Massapequa, NY | $67.47 | $54.01 – $73.34 | 7,603 | 2 |
| Merrill, OR | $48.43 | $48.43 – $48.43 | 7,599 | 1 |
| Raleigh, MS | $62.45 | $45.84 – $136.02 | 7,598 | 6 |
| Dunbar, PA | $33.51 | $19.76 – $34.00 | 7,597 | 3 |
| Brewster, MA | $50.18 | $13.02 – $62.70 | 7,591 | 8 |
| Lynnville, IN | $50.77 | $45.66 – $53.40 | 7,590 | 3 |
| Polo, IL | $54.41 | $45.65 – $63.03 | 7,590 | 3 |
| Appleton, MN | $171.87 | $59.12 – $229.99 | 7,588 | 5 |
| Klawock, AK | $333.20 | $142.02 – $691.07 | 7,584 | 6 |
| Waunakee, WI | $159.74 | $7.41 – $403.76 | 7,584 | 13 |
| Montcalm, WV | $9.82 | $9.82 – $9.82 | 7,581 | 1 |
| Addison, AL | $47.60 | $43.94 – $57.83 | 7,580 | 4 |
| Glenns Ferry, ID | $54.07 | $0.06 – $69.74 | 7,579 | 3 |
| North Bend, WA | $57.75 | $17.85 – $73.84 | 7,579 | 5 |
| Ebensburg, PA | $21.21 | $0.00 – $51.39 | 7,577 | 14 |
| Decatur, MI | $2.96 | $2.96 – $2.96 | 7,575 | 1 |
| Gladstone, OR | $83.63 | $60.81 – $104.93 | 7,574 | 6 |
| Ninilchik, AK | $545.29 | $366.65 – $686.69 | 7,561 | 5 |
| Kaukauna, WI | $28.83 | $20.94 – $68.29 | 7,550 | 15 |
| Traverse, MI | $8.15 | $8.15 – $8.15 | 7,547 | 1 |
| Hoschton, GA | $47.02 | $44.21 – $58.06 | 7,546 | 3 |
| Stateline, NV | $48.35 | $28.53 – $79.91 | 7,544 | 11 |
| Nunapitchuk, AK | $246.50 | $0.00 – $421.05 | 7,540 | 5 |
| Marissa, IL | $0.20 | $0.20 – $0.20 | 7,540 | 1 |
| Rockville Ctre, NY | $49.74 | $49.74 – $49.74 | 7,539 | 1 |
| Foster, KY | $38.56 | $38.56 – $38.56 | 7,531 | 1 |
| Troutville, VA | $63.67 | $44.20 – $73.97 | 7,531 | 6 |
| Baxter, IA | $33.02 | $33.02 – $33.02 | 7,525 | 1 |
| Woodbine, IA | $0.00 | $0.00 – $0.00 | 7,523 | 1 |
| Manlius, NY | $68.38 | $0.00 – $203.13 | 7,521 | 15 |
| Hugoton, KS | $178.44 | $28.38 – $187.19 | 7,520 | 5 |
| Wells River, VT | $0.04 | $0.00 – $0.80 | 7,517 | 6 |
| Licking, MO | $65.34 | $57.00 – $88.34 | 7,515 | 4 |
| Oconto Falls, WI | $52.12 | $12.49 – $280.49 | 7,514 | 20 |
| Robstown, TX | $34.61 | $13.75 – $59.41 | 7,512 | 6 |
| Tustin, MI | $22.83 | $1.83 – $59.43 | 7,503 | 4 |
| Jbsa Randolph, TX | $43.55 | $31.51 – $92.30 | 7,497 | 5 |
| Trent Woods, NC | $49.34 | $19.22 – $85.44 | 7,492 | 5 |
| Ensenada, PR | $0.82 | $0.82 – $0.82 | 7,490 | 1 |
| Wilson, MI | $0.73 | $0.73 – $0.73 | 7,489 | 1 |
| Washburn, TN | $39.29 | $29.18 – $45.16 | 7,487 | 3 |
| Atascocita, TX | $52.40 | $36.55 – $66.48 | 7,487 | 4 |
| Kenly, NC | $43.55 | $0.00 – $51.36 | 7,484 | 7 |
| Gosport, IN | $57.81 | $49.72 – $105.40 | 7,481 | 5 |
| Millis, MA | $97.92 | $2.84 – $122.28 | 7,469 | 9 |
| Stockton Springs, ME | $16.59 | $16.59 – $16.59 | 7,463 | 1 |
| Johnson Creek, WI | $17.16 | $4.84 – $31.14 | 7,460 | 6 |
| Tecumseh, OK | $143.37 | $92.84 – $174.36 | 7,460 | 2 |
| Merriam, KS | $45.47 | $17.13 – $207.79 | 7,457 | 40 |
| Carnegie, PA | $44.96 | $16.01 – $67.00 | 7,457 | 11 |
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.