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 |
|---|---|---|---|---|
| Highlands, NC | $31.30 | $4.02 – $62.26 | 5,723 | 8 |
| Osage City, KS | $46.84 | $26.49 – $86.78 | 5,717 | 5 |
| Willow, AK | $82.75 | $0.00 – $118.01 | 5,710 | 2 |
| Cardington, OH | $45.91 | $0.00 – $49.19 | 5,709 | 3 |
| Ennis, MT | $1.12 | $0.19 – $64.33 | 5,709 | 3 |
| Davis Junction, IL | $59.71 | $22.76 – $69.74 | 5,704 | 5 |
| Argyle, TX | $59.53 | $44.98 – $89.81 | 5,702 | 5 |
| Hampton, NH | $37.43 | $22.36 – $62.33 | 5,700 | 17 |
| Cecilton, MD | $92.24 | $16.07 – $112.29 | 5,700 | 2 |
| Vancouvar, WA | $30.16 | $30.16 – $30.16 | 5,700 | 1 |
| Westminster, MA | $47.11 | $4.90 – $76.95 | 5,698 | 8 |
| Caldwell, NJ | $43.76 | $24.08 – $115.22 | 5,696 | 6 |
| Monument Valley, UT | $412.50 | $81.56 – $428.96 | 5,693 | 3 |
| Cochranton, PA | $60.47 | $51.09 – $62.11 | 5,692 | 2 |
| Bovina, TX | $51.89 | $51.89 – $51.89 | 5,687 | 1 |
| North Cape May, NJ | $51.73 | $50.82 – $58.69 | 5,684 | 3 |
| Lobelville, TN | $25.91 | $19.89 – $26.26 | 5,680 | 2 |
| Slocomb, AL | $9.50 | $0.00 – $33.18 | 5,680 | 3 |
| West Salem, IL | $0.00 | $0.00 – $0.00 | 5,675 | 1 |
| Center City, MN | $93.13 | $28.77 – $241.59 | 5,674 | 5 |
| Mount Morris, PA | $63.51 | $0.09 – $102.35 | 5,674 | 4 |
| Fort Gibson, OK | $88.11 | $58.56 – $112.25 | 5,664 | 6 |
| Transfer, PA | $25.31 | $0.00 – $80.32 | 5,662 | 5 |
| Highland, AR | $29.44 | $0.00 – $41.54 | 5,657 | 6 |
| Spencerville, OH | $38.47 | $22.34 – $43.30 | 5,657 | 3 |
| Sinajana, GU | $156.75 | $75.14 – $172.52 | 5,656 | 4 |
| Wlliamsburg, KY | $30.58 | $30.58 – $30.58 | 5,653 | 1 |
| Saint Regis, MT | $1.10 | $0.00 – $65.53 | 5,651 | 2 |
| Fairbury, IL | $41.40 | $0.00 – $67.15 | 5,648 | 8 |
| Dove Creek, CO | $65.85 | $65.85 – $65.85 | 5,646 | 1 |
| Barrington, NJ | $74.16 | $0.00 – $92.42 | 5,646 | 6 |
| Monticello, FL | $49.98 | $17.58 – $51.93 | 5,645 | 4 |
| Port Orford, OR | $34.68 | $17.17 – $41.52 | 5,642 | 3 |
| Byron, GA | $102.40 | $46.01 – $102.55 | 5,642 | 2 |
| Coatsville, PA | $63.31 | $51.96 – $66.06 | 5,640 | 3 |
| Glide, OR | $51.95 | $51.36 – $58.17 | 5,638 | 2 |
| Baileyton, AL | $56.74 | $0.00 – $68.86 | 5,638 | 6 |
| West Henrietta, NY | $95.22 | $72.57 – $105.75 | 5,631 | 3 |
| Winnebago, NE | $45.39 | $0.00 – $370.12 | 5,619 | 7 |
| Selbyville, DE | $88.72 | $2.37 – $122.53 | 5,617 | 7 |
| San Martin, CA | $4.46 | $3.50 – $33.45 | 5,617 | 3 |
| Kings Mountain, KY | $30.64 | $30.64 – $30.64 | 5,614 | 1 |
| Windsor, NY | $65.13 | $49.46 – $66.74 | 5,613 | 4 |
| Kelseyville, CA | $21.61 | $0.00 – $32.64 | 5,611 | 6 |
| Squaw Valley, CA | $5.55 | $1.66 – $14.68 | 5,611 | 3 |
| Glenarden, MD | $113.99 | $76.00 – $114.76 | 5,611 | 3 |
| Seagoville, TX | $28.80 | $1.47 – $32.60 | 5,611 | 4 |
| Lincoln, DE | $54.16 | $54.16 – $54.16 | 5,607 | 1 |
| Delta, OH | $59.12 | $24.44 – $107.64 | 5,606 | 7 |
| South Pasadena, FL | $44.74 | $4.51 – $61.26 | 5,604 | 12 |
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.