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 |
|---|---|---|---|---|
| Rio Grande, OH | $40.43 | $40.43 – $40.43 | 6,209 | 1 |
| Newport, MI | $24.46 | $1.53 – $75.64 | 6,207 | 3 |
| Canastota, NY | $67.82 | $42.70 – $102.28 | 6,206 | 6 |
| Shrewsbury, PA | $27.01 | $1.31 – $52.15 | 6,206 | 9 |
| Riverside, CT | $65.10 | $0.00 – $91.48 | 6,204 | 6 |
| Fredonia, KY | $28.47 | $11.89 – $33.91 | 6,203 | 5 |
| Lindon, UT | $47.96 | $2.32 – $89.15 | 6,202 | 9 |
| White Sulphur Springs, WV | $34.17 | $8.64 – $56.80 | 6,200 | 2 |
| Rittman, OH | $45.54 | $37.99 – $55.41 | 6,200 | 4 |
| College Dale, TN | $38.12 | $11.76 – $38.42 | 6,197 | 2 |
| Park River, ND | $145.47 | $50.26 – $148.20 | 6,193 | 4 |
| Kimball, NE | $76.04 | $20.35 – $90.78 | 6,188 | 7 |
| Winfield, MO | $47.55 | $19.20 – $62.50 | 6,187 | 2 |
| Stokesdale, NC | $70.34 | $67.93 – $75.98 | 6,186 | 2 |
| Brodhead, WI | $30.76 | $16.65 – $36.77 | 6,186 | 9 |
| Wantage, NJ | $62.83 | $62.83 – $62.83 | 6,184 | 1 |
| Joshua Tree, CA | $70.50 | $1.40 – $394.76 | 6,174 | 5 |
| Elysburg, PA | $45.23 | $37.63 – $101.61 | 6,170 | 6 |
| Harbor Springs, MI | $49.16 | $12.06 – $68.96 | 6,167 | 3 |
| Shaftsbury, VT | $51.82 | $30.13 – $63.99 | 6,164 | 6 |
| Florida, NY | $77.86 | $69.76 – $88.03 | 6,160 | 3 |
| Cozad, NE | $97.40 | $30.92 – $143.57 | 6,159 | 10 |
| S Weymouth, MA | $48.22 | $27.63 – $79.82 | 6,158 | 6 |
| Country Club Hills, IL | $82.68 | $47.32 – $232.39 | 6,155 | 3 |
| Harmony, FL | $39.53 | $39.53 – $39.53 | 6,152 | 1 |
| Marshfield, MA | $67.52 | $56.31 – $97.01 | 6,152 | 8 |
| Eagle Lake, ME | $5.42 | $5.42 – $5.42 | 6,151 | 1 |
| Flat Rock, MI | $69.67 | $23.56 – $86.21 | 6,150 | 6 |
| Myrtle, MS | $57.39 | $26.05 – $99.23 | 6,149 | 3 |
| Port Byron, NY | $61.14 | $45.91 – $67.06 | 6,143 | 2 |
| Staten Islan, NY | $20.90 | $20.90 – $20.90 | 6,142 | 1 |
| Heyburn, ID | $41.50 | $41.50 – $41.50 | 6,141 | 1 |
| Bryant, AL | $10.47 | $0.07 – $73.74 | 6,140 | 3 |
| Patagonia, AZ | $0.14 | $0.14 – $0.14 | 6,135 | 1 |
| Penasco, NM | $119.91 | $119.39 – $164.40 | 6,132 | 2 |
| Mcadenville, NC | $55.68 | $51.34 – $63.19 | 6,129 | 2 |
| Bourbon, IN | $46.58 | $40.20 – $58.89 | 6,126 | 4 |
| Etters, PA | $48.52 | $41.88 – $56.82 | 6,123 | 6 |
| Cusseta, GA | $89.66 | $89.66 – $89.66 | 6,122 | 1 |
| Luiquillo, PR | $0.76 | $0.76 – $0.76 | 6,115 | 1 |
| Saint Stephen, SC | $66.70 | $58.20 – $70.55 | 6,115 | 3 |
| Dripping Springs, TX | $67.64 | $0.39 – $133.18 | 6,109 | 7 |
| Dubois, PA | $35.46 | $35.04 – $54.07 | 6,108 | 6 |
| Williamstown, WV | $56.73 | $24.22 – $73.16 | 6,103 | 12 |
| Three Forks, MT | $0.00 | $0.00 – $0.00 | 6,096 | 2 |
| Newburg, WV | $6.62 | $0.00 – $12.33 | 6,093 | 3 |
| Mclean, VA | $57.40 | $32.10 – $184.35 | 6,087 | 9 |
| Hamilton, MO | $61.26 | $60.95 – $65.57 | 6,086 | 2 |
| Whitefish Bay, WI | $29.40 | $6.17 – $53.74 | 6,083 | 12 |
| Arma, KS | $123.79 | $26.79 – $149.71 | 6,082 | 5 |
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.