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 |
|---|---|---|---|---|
| Northampton, PA | $41.72 | $1.07 – $49.17 | 6,676 | 7 |
| Creighton, NE | $48.37 | $12.33 – $98.64 | 6,669 | 8 |
| Holmen, WI | $25.81 | $11.29 – $37.98 | 6,662 | 10 |
| Cherokee Village, AR | $30.01 | $1.69 – $50.05 | 6,660 | 8 |
| Strasburg, PA | $39.99 | $18.02 – $48.21 | 6,658 | 8 |
| Pandora, OH | $43.45 | $34.63 – $46.96 | 6,657 | 7 |
| Bella Vista, AR | $63.87 | $6.95 – $311.34 | 6,656 | 12 |
| Lithia Springs, GA | $70.64 | $54.12 – $75.84 | 6,655 | 3 |
| Puerto Rico, PR | $41.63 | $41.63 – $41.63 | 6,653 | 1 |
| Comanche, OK | $96.50 | $95.66 – $98.96 | 6,649 | 2 |
| Eagle Point, OR | $72.58 | $37.83 – $116.11 | 6,649 | 7 |
| South Royalton, VT | $39.31 | $17.02 – $108.06 | 6,646 | 3 |
| Gowrie, IA | $0.03 | $0.03 – $0.03 | 6,646 | 1 |
| Pacific City, OR | $57.52 | $42.68 – $70.06 | 6,645 | 3 |
| Bloomfield, NM | $278.08 | $65.76 – $349.10 | 6,643 | 2 |
| Collingdale, PA | $50.18 | $34.41 – $52.74 | 6,637 | 2 |
| Hopelawn, NJ | $43.65 | $43.65 – $43.65 | 6,635 | 1 |
| Arnaudville, LA | $43.03 | $0.00 – $52.20 | 6,634 | 4 |
| Westnewyork, NJ | $15.42 | $15.42 – $15.42 | 6,633 | 1 |
| Los Alamos, CA | $0.78 | $0.78 – $0.78 | 6,631 | 1 |
| Ft. Cobb, OK | $10.53 | $10.53 – $10.53 | 6,627 | 1 |
| Woodstock, VT | $27.83 | $12.66 – $50.88 | 6,627 | 5 |
| Kimball, MI | $49.97 | $49.97 – $49.97 | 6,625 | 1 |
| Monroe City, IN | $49.76 | $45.93 – $61.11 | 6,616 | 3 |
| Saint Paul, NE | $80.02 | $0.00 – $168.93 | 6,615 | 11 |
| Green Island, NY | $63.28 | $55.00 – $84.64 | 6,612 | 4 |
| Moncure, NC | $73.65 | $6.65 – $81.30 | 6,606 | 3 |
| Tellico, TN | $42.34 | $42.34 – $42.34 | 6,604 | 1 |
| Webster Groves, MO | $34.77 | $16.26 – $77.17 | 6,601 | 7 |
| Wallkill, NY | $69.36 | $63.04 – $88.54 | 6,599 | 3 |
| Ramer, AL | $18.13 | $0.00 – $28.98 | 6,598 | 3 |
| Powder Springs, GA | $85.14 | $47.66 – $426.63 | 6,596 | 5 |
| Peak, SC | $49.50 | $29.07 – $56.83 | 6,585 | 5 |
| Eaton, CO | $67.79 | $42.74 – $124.66 | 6,584 | 5 |
| Alachua, FL | $33.05 | $3.57 – $77.94 | 6,583 | 6 |
| Challis, ID | $7.91 | $2.15 – $23.83 | 6,582 | 7 |
| Lake Ozark, MO | $72.78 | $27.61 – $110.82 | 6,582 | 12 |
| Suring, WI | $50.30 | $23.66 – $50.36 | 6,581 | 2 |
| Clearwater, MN | $69.64 | $68.33 – $77.63 | 6,580 | 3 |
| West Union, WV | $40.54 | $0.00 – $81.60 | 6,568 | 7 |
| Weston, MA | $44.80 | $4.85 – $92.51 | 6,568 | 24 |
| Fort Duchesne, UT | $414.66 | $293.86 – $537.57 | 6,564 | 3 |
| Cincinnatus, NY | $89.44 | $75.31 – $103.60 | 6,562 | 4 |
| Otsego, MI | $14.90 | $1.14 – $47.81 | 6,561 | 3 |
| Upton, MA | $39.21 | $30.14 – $55.53 | 6,553 | 8 |
| Weimar, TX | $33.64 | $3.59 – $40.14 | 6,551 | 4 |
| Molalla, OR | $39.19 | $11.88 – $71.80 | 6,551 | 10 |
| Chestertown, NY | $66.55 | $66.48 – $94.95 | 6,549 | 2 |
| Whitehouse, TX | $17.41 | $8.57 – $63.35 | 6,546 | 10 |
| Ware Shoals, SC | $68.65 | $62.93 – $223.39 | 6,544 | 3 |
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.