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 |
|---|---|---|---|---|
| Woodville, AL | $0.00 | $0.00 – $0.00 | 7,456 | 2 |
| Stansbury Park, UT | $53.58 | $37.01 – $417.49 | 7,454 | 10 |
| Scuddy, KY | $9.10 | $9.10 – $9.10 | 7,454 | 1 |
| Slaton, TX | $28.45 | $0.12 – $42.72 | 7,446 | 3 |
| Smithers, WV | $25.26 | $0.00 – $63.87 | 7,442 | 4 |
| Napavine, WA | $52.97 | $44.45 – $73.79 | 7,441 | 3 |
| Mt Shasta, CA | $8.55 | $3.03 – $41.32 | 7,432 | 2 |
| Neah Bay, WA | $44.33 | $26.29 – $55.84 | 7,429 | 9 |
| Tavernier, FL | $71.63 | $10.46 – $107.53 | 7,428 | 9 |
| Sandersville, MS | $69.30 | $27.51 – $70.32 | 7,426 | 3 |
| Isle Of Palms, SC | $70.89 | $39.37 – $74.72 | 7,424 | 2 |
| Ramsey, MN | $73.00 | $59.57 – $228.52 | 7,419 | 14 |
| Willow Street, PA | $59.71 | $24.39 – $91.86 | 7,416 | 15 |
| Plattsburg, MO | $49.64 | $16.97 – $57.06 | 7,416 | 4 |
| Rutherford, TN | $32.04 | $23.05 – $32.65 | 7,406 | 3 |
| Altamont, NY | $94.95 | $0.00 – $101.37 | 7,386 | 9 |
| Richwood, WV | $33.74 | $0.39 – $37.47 | 7,385 | 3 |
| Park Hills, MO | $18.01 | $17.84 – $19.62 | 7,383 | 3 |
| Shawneetown, IL | $0.00 | $0.00 – $0.00 | 7,382 | 1 |
| Dysart, IA | $38.14 | $38.14 – $38.14 | 7,380 | 1 |
| Warroad, MN | $43.25 | $40.63 – $65.06 | 7,378 | 4 |
| Lytle, TX | $51.71 | $26.30 – $74.97 | 7,378 | 5 |
| Emporium, PA | $8.73 | $0.12 – $41.20 | 7,378 | 3 |
| Grand Marais, MN | $185.20 | $36.98 – $311.34 | 7,377 | 9 |
| Hobe Sound, FL | $19.93 | $6.94 – $39.95 | 7,371 | 3 |
| Potlatch, ID | $66.68 | $0.66 – $70.47 | 7,370 | 4 |
| S Richmond Hills, NY | $72.65 | $72.65 – $72.65 | 7,363 | 1 |
| Bude, MS | $63.00 | $24.16 – $99.68 | 7,360 | 3 |
| Goreville, IL | $0.00 | $0.00 – $0.00 | 7,359 | 1 |
| Kewaskum, WI | $33.86 | $21.41 – $48.28 | 7,356 | 8 |
| Sterling, KS | $186.30 | $163.92 – $186.34 | 7,355 | 2 |
| Springerville, AZ | $15.73 | $0.10 – $111.62 | 7,351 | 6 |
| Mc Gregor, TX | $37.55 | $37.55 – $37.55 | 7,349 | 1 |
| Sipsey, AL | $63.96 | $45.72 – $97.36 | 7,344 | 2 |
| Ellerbe, NC | $52.53 | $45.79 – $57.61 | 7,339 | 3 |
| Jemez Pueblo, NM | $69.06 | $8.61 – $457.50 | 7,337 | 5 |
| Bristol, FL | $29.11 | $16.44 – $35.40 | 7,332 | 6 |
| Tenino, WA | $40.94 | $14.22 – $52.28 | 7,330 | 4 |
| Oologah, OK | $80.05 | $69.83 – $80.39 | 7,329 | 2 |
| Montgomery, TX | $99.85 | $36.51 – $275.05 | 7,328 | 8 |
| Washington, MI | $53.26 | $41.99 – $80.26 | 7,321 | 3 |
| Geneva, NE | $59.04 | $28.27 – $70.27 | 7,320 | 8 |
| Flushuing, NY | $60.88 | $60.88 – $60.88 | 7,313 | 1 |
| Harrah, OK | $56.00 | $18.97 – $99.83 | 7,305 | 8 |
| Moss Bluff, LA | $48.77 | $48.22 – $55.70 | 7,298 | 2 |
| Sheridan, MT | $18.30 | $0.00 – $103.35 | 7,297 | 3 |
| Valley, NE | $63.65 | $36.90 – $80.65 | 7,295 | 8 |
| Manheim, PA | $48.43 | $28.37 – $55.21 | 7,291 | 8 |
| Ketchum, ID | $41.96 | $9.54 – $124.33 | 7,286 | 6 |
| Loudonville, NY | $62.02 | $53.37 – $74.53 | 7,285 | 10 |
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.