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 |
|---|---|---|---|---|
| Rockwell, NC | $60.58 | $31.79 – $65.89 | 6,071 | 4 |
| Kellyton, AL | $0.00 | $0.00 – $0.00 | 6,069 | 1 |
| Angeles, PR | $54.86 | $0.00 – $55.01 | 6,068 | 2 |
| University Park, FL | $44.61 | $40.99 – $63.77 | 6,067 | 2 |
| O'Fallon, MO | $45.87 | $31.63 – $118.15 | 6,066 | 5 |
| Marion, KS | $129.05 | $22.54 – $144.23 | 6,063 | 5 |
| Anaheim Hills, CA | $23.70 | $0.00 – $48.72 | 6,059 | 5 |
| Nederland, CO | $54.99 | $52.80 – $90.68 | 6,054 | 2 |
| Kimberly, WI | $35.20 | $0.00 – $41.35 | 6,054 | 10 |
| Otisville, MI | $59.00 | $59.00 – $59.00 | 6,052 | 1 |
| Caldwell, KS | $67.74 | $25.62 – $81.76 | 6,052 | 5 |
| Clarksville, MD | $77.63 | $24.76 – $133.49 | 6,051 | 7 |
| Mangum, OK | $96.06 | $57.01 – $237.34 | 6,050 | 4 |
| Hinckley, IL | $48.50 | $47.85 – $50.22 | 6,040 | 2 |
| Lago Vista, TX | $64.40 | $0.00 – $65.84 | 6,037 | 4 |
| West Alherst, NY | $56.75 | $56.75 – $56.75 | 6,035 | 1 |
| Shady Cove, OR | $63.19 | $3.43 – $115.37 | 6,032 | 5 |
| Galena, AK | $343.54 | $101.61 – $696.48 | 6,032 | 6 |
| Ashland, PA | $38.08 | $34.53 – $38.43 | 6,032 | 2 |
| Coopersville, MI | $3.05 | $1.55 – $64.32 | 6,031 | 2 |
| Ocean View, NJ | $51.72 | $8.35 – $67.50 | 6,031 | 9 |
| Valentine, NE | $96.09 | $30.03 – $177.47 | 6,031 | 10 |
| Carrolltown, PA | $14.02 | $0.00 – $65.65 | 6,028 | 4 |
| Tularosa, NM | $143.17 | $79.00 – $150.27 | 6,027 | 3 |
| Liberty Hill, TX | $37.35 | $25.52 – $130.19 | 6,026 | 6 |
| Taneytown, MD | $89.78 | $55.74 – $100.08 | 6,022 | 3 |
| Springfield, GA | $59.75 | $11.95 – $81.03 | 6,019 | 6 |
| Dale, IN | $45.78 | $43.58 – $58.21 | 6,019 | 3 |
| Samson, AL | $8.90 | $0.00 – $43.66 | 6,019 | 4 |
| Colorado City, CO | $62.80 | $20.04 – $100.58 | 6,017 | 7 |
| Moodus, CT | $77.16 | $76.70 – $80.48 | 6,016 | 2 |
| Laurel, DE | $33.84 | $1.50 – $71.19 | 6,016 | 11 |
| Vail, CO | $95.63 | $33.30 – $171.32 | 6,013 | 13 |
| Hodges, SC | $42.39 | $25.68 – $85.94 | 6,012 | 5 |
| Laureldale, PA | $22.81 | $8.91 – $55.06 | 6,010 | 4 |
| Bantam, CT | $76.91 | $8.65 – $89.48 | 6,009 | 2 |
| Mountainair, NM | $146.58 | $146.58 – $146.58 | 6,009 | 1 |
| Wayland, MI | $5.08 | $3.23 – $63.50 | 6,008 | 2 |
| Mount Arlington, NJ | $72.36 | $36.08 – $102.24 | 5,999 | 7 |
| Vinton, TX | $62.67 | $57.21 – $64.13 | 5,999 | 2 |
| Fair Bluff, NC | $35.80 | $32.18 – $36.11 | 5,998 | 2 |
| Milton, KY | $32.55 | $32.32 – $32.64 | 5,997 | 2 |
| Lyons, IL | $62.62 | $37.57 – $64.33 | 5,987 | 3 |
| Falls Of Rough, KY | $32.28 | $32.28 – $32.28 | 5,986 | 1 |
| Rio Ranch, NM | $90.83 | $90.83 – $90.83 | 5,985 | 1 |
| Seekonk, MA | $52.86 | $13.19 – $94.78 | 5,982 | 7 |
| Trujillo Alro, PR | $59.33 | $59.33 – $59.33 | 5,981 | 1 |
| California, PA | $65.65 | $0.00 – $74.74 | 5,979 | 3 |
| Palos Park, IL | $45.90 | $21.94 – $64.78 | 5,979 | 17 |
| Ashland, MO | $116.72 | $27.48 – $556.12 | 5,979 | 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.