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 |
|---|---|---|---|---|
| Converse, TX | $43.39 | $23.31 – $50.59 | 7,160 | 4 |
| Pelham, GA | $39.61 | $29.54 – $60.95 | 7,152 | 3 |
| Ortonville, MI | $62.69 | $26.52 – $77.91 | 7,148 | 3 |
| Lakewood, WI | $33.30 | $31.07 – $43.23 | 7,147 | 3 |
| Bakersville, NC | $59.84 | $0.00 – $74.74 | 7,139 | 7 |
| Arcade, NY | $50.88 | $48.95 – $82.11 | 7,136 | 2 |
| Pilot Station, AK | $401.98 | $389.18 – $427.65 | 7,130 | 3 |
| Troy, IL | $51.25 | $19.18 – $60.65 | 7,127 | 5 |
| Shawnee Mission, KS | $139.73 | $23.83 – $176.37 | 7,125 | 14 |
| Melbourne, AR | $23.60 | $2.34 – $31.52 | 7,120 | 5 |
| Oberlin, KS | $92.92 | $44.84 – $130.25 | 7,117 | 3 |
| Oklahoma, OK | $88.46 | $1.55 – $145.73 | 7,117 | 4 |
| Wall, NJ | $47.05 | $17.10 – $58.05 | 7,112 | 8 |
| Interlachen, FL | $44.50 | $1.85 – $91.67 | 7,105 | 6 |
| Haines, AK | $318.00 | $124.36 – $700.88 | 7,092 | 5 |
| Lansing, IL | $68.78 | $14.49 – $286.40 | 7,090 | 7 |
| Flourtown, PA | $62.47 | $0.92 – $146.34 | 7,090 | 19 |
| Georgetown, CA | $22.38 | $0.00 – $26.00 | 7,090 | 4 |
| Wilkes-Barre, PA | $47.07 | $0.00 – $70.22 | 7,088 | 13 |
| Urbana, IA | $0.11 | $0.04 – $32.80 | 7,088 | 2 |
| Wright City, OK | $74.51 | $70.68 – $80.25 | 7,084 | 2 |
| Lyles, TN | $30.70 | $18.71 – $38.03 | 7,084 | 3 |
| Groveton, NH | $123.06 | $97.13 – $153.42 | 7,084 | 4 |
| Westminster, SC | $63.11 | $63.11 – $63.11 | 7,082 | 1 |
| Saint James, MO | $84.41 | $46.45 – $396.86 | 7,081 | 9 |
| Parkston, SD | $74.68 | $31.11 – $74.79 | 7,081 | 2 |
| Andrews, NC | $22.63 | $1.25 – $40.20 | 7,076 | 7 |
| Edinboro, PA | $45.12 | $35.93 – $55.38 | 7,076 | 12 |
| Fort Leonard Wood, MO | $94.56 | $0.00 – $427.45 | 7,074 | 23 |
| Ogden, IA | $12.01 | $2.55 – $36.94 | 7,074 | 6 |
| Geraldine, AL | $16.40 | $0.00 – $16.45 | 7,073 | 2 |
| Green Lake, WI | $34.23 | $15.28 – $45.36 | 7,071 | 7 |
| Kipnuk, AK | $188.98 | $0.00 – $433.52 | 7,066 | 6 |
| Bigfork, MN | $357.96 | $80.70 – $602.35 | 7,064 | 11 |
| Millersport, OH | $52.98 | $30.00 – $126.91 | 7,046 | 4 |
| North Reading, MA | $47.25 | $15.65 – $79.50 | 7,043 | 7 |
| Cedarburg, WI | $37.54 | $18.28 – $268.42 | 7,033 | 17 |
| Villisca, IA | $7.20 | $0.02 – $35.22 | 7,031 | 3 |
| North Dighton, MA | $38.91 | $35.30 – $58.32 | 7,027 | 3 |
| Bullhead, AZ | $0.02 | $0.02 – $0.02 | 7,026 | 1 |
| Brookline, MO | $90.14 | $36.40 – $110.39 | 7,021 | 8 |
| Castle Rock, WA | $30.51 | $0.00 – $41.99 | 7,021 | 4 |
| No. Las Vegas, NV | $47.13 | $47.13 – $47.13 | 7,019 | 1 |
| Pleasant View, UT | $64.14 | $30.05 – $70.57 | 7,016 | 12 |
| Campbellsburg, IN | $53.44 | $53.44 – $53.44 | 7,015 | 1 |
| Craigsville, WV | $30.46 | $0.06 – $86.97 | 7,013 | 3 |
| Annville, KY | $21.50 | $0.00 – $21.57 | 7,012 | 2 |
| Middleburg, VA | $53.13 | $53.13 – $53.13 | 7,006 | 1 |
| Inwood, WV | $60.23 | $3.28 – $67.93 | 7,005 | 6 |
| Duxbury, MA | $58.03 | $7.86 – $78.14 | 7,000 | 14 |
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.