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 |
|---|---|---|---|---|
| Elmira, OR | $59.13 | $5.15 – $76.13 | 5,520 | 4 |
| Kansas, OK | $69.81 | $0.00 – $82.25 | 5,519 | 4 |
| Jamaica Hills, NY | $61.54 | $61.54 – $61.54 | 5,518 | 1 |
| Lake Toxaway, NC | $31.33 | $28.86 – $38.87 | 5,517 | 2 |
| Mathias, WV | $8.17 | $0.00 – $10.39 | 5,517 | 2 |
| Spring Park, MN | $43.28 | $36.89 – $65.02 | 5,516 | 5 |
| Rock Port, MO | $37.69 | $37.69 – $37.69 | 5,515 | 1 |
| Mount Joy, PA | $67.90 | $46.21 – $75.78 | 5,509 | 6 |
| Vernon, NY | $78.95 | $59.67 – $82.42 | 5,505 | 6 |
| Ovid, NY | $65.81 | $63.90 – $207.80 | 5,504 | 3 |
| Springer, NM | $162.16 | $162.16 – $162.16 | 5,504 | 1 |
| Swarthmore, PA | $56.11 | $56.11 – $56.11 | 5,502 | 1 |
| Collinwood, TN | $33.47 | $18.46 – $34.32 | 5,502 | 2 |
| Honolullu, HI | $39.25 | $39.25 – $39.25 | 5,501 | 1 |
| Washburn, WI | $17.40 | $10.94 – $27.29 | 5,496 | 3 |
| Newellton, LA | $0.13 | $0.01 – $22.88 | 5,493 | 2 |
| Wakefield, MI | $338.93 | $28.11 – $426.09 | 5,493 | 3 |
| Boiling Springs, NC | $60.45 | $39.05 – $78.02 | 5,492 | 5 |
| Birmingham, LA | $77.20 | $77.20 – $77.20 | 5,492 | 1 |
| Cape Charles, VA | $41.32 | $24.14 – $49.29 | 5,489 | 4 |
| Kinsman, OH | $44.95 | $32.57 – $62.62 | 5,488 | 6 |
| Monroe, IN | $61.74 | $39.57 – $70.25 | 5,483 | 6 |
| Philip, SD | $77.56 | $77.56 – $77.56 | 5,483 | 1 |
| Grindstone, PA | $39.02 | $31.78 – $52.43 | 5,481 | 3 |
| New Prague, MN | $68.78 | $3.42 – $86.20 | 5,480 | 13 |
| Highwood, IL | $48.42 | $12.78 – $56.94 | 5,479 | 2 |
| Naranjuo, PR | $0.70 | $0.70 – $0.70 | 5,475 | 1 |
| New London, IA | $10.14 | $0.00 – $14.51 | 5,475 | 4 |
| Skillman, NJ | $36.31 | $31.93 – $83.86 | 5,473 | 3 |
| Delbarton, WV | $27.36 | $0.00 – $29.42 | 5,471 | 3 |
| Palmyra, IN | $50.39 | $50.39 – $50.39 | 5,468 | 1 |
| Colorado City, AZ | $36.73 | $29.98 – $66.38 | 5,467 | 2 |
| Whitinsville, MA | $52.92 | $18.77 – $111.94 | 5,460 | 4 |
| Roanoke, IL | $48.10 | $0.00 – $69.49 | 5,459 | 13 |
| Dingmans Ferry, PA | $30.93 | $0.49 – $38.81 | 5,459 | 3 |
| Fremont, IN | $49.91 | $31.07 – $62.17 | 5,454 | 3 |
| East Dubuque, IL | $38.02 | $38.02 – $38.02 | 5,451 | 1 |
| Yerington, NV | $90.68 | $0.00 – $159.75 | 5,450 | 7 |
| Hagerstown, IN | $62.32 | $35.16 – $74.72 | 5,449 | 3 |
| Independence, VA | $38.47 | $15.05 – $57.10 | 5,447 | 4 |
| Newfoundland, NJ | $33.56 | $31.92 – $75.63 | 5,444 | 2 |
| Rolling Hills Estates, CA | $6.08 | $0.00 – $46.11 | 5,440 | 3 |
| Forsyth, MT | $0.56 | $0.00 – $97.91 | 5,439 | 2 |
| Hollister, MO | $69.61 | $25.38 – $97.37 | 5,433 | 7 |
| Highlands, NJ | $26.98 | $11.17 – $58.33 | 5,432 | 3 |
| Kinnelon, NJ | $46.67 | $16.49 – $94.56 | 5,431 | 6 |
| Miracle, KY | $33.89 | $33.89 – $33.89 | 5,429 | 1 |
| Benton, PA | $39.17 | $39.17 – $39.17 | 5,420 | 1 |
| North Creek, NY | $64.69 | $32.23 – $79.32 | 5,420 | 4 |
| Axton, VA | $47.20 | $47.13 – $68.83 | 5,415 | 2 |
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.