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 |
|---|---|---|---|---|
| Newbury, OH | $65.77 | $26.29 – $86.52 | 5,305 | 5 |
| Brook, IN | $54.78 | $48.97 – $62.07 | 5,295 | 3 |
| Ellenwood, GA | $48.60 | $2.35 – $61.00 | 5,294 | 7 |
| Little Hocking, OH | $70.54 | $69.78 – $80.61 | 5,294 | 2 |
| Pineville, MO | $67.62 | $14.69 – $137.24 | 5,293 | 6 |
| Loudonville, OH | $36.92 | $25.84 – $51.51 | 5,292 | 6 |
| Akiachak, AK | $107.13 | $0.00 – $183.97 | 5,289 | 5 |
| Mount Morris, NY | $80.83 | $59.78 – $85.27 | 5,289 | 3 |
| Jasonville, IN | $47.27 | $47.27 – $47.27 | 5,284 | 1 |
| Tremont, IL | $26.73 | $11.63 – $52.44 | 5,277 | 4 |
| Port Ludlow, WA | $30.00 | $0.00 – $44.02 | 5,272 | 3 |
| Cashiers, NC | $36.82 | $31.58 – $51.72 | 5,270 | 5 |
| Trumansburg, NY | $82.35 | $49.87 – $94.79 | 5,267 | 11 |
| University Park, MD | $120.58 | $97.96 – $122.72 | 5,264 | 3 |
| East Hanover, NJ | $65.02 | $0.00 – $96.85 | 5,263 | 9 |
| Antwerp, OH | $38.75 | $29.79 – $43.70 | 5,259 | 5 |
| Bushnell, IL | $0.70 | $0.15 – $21.38 | 5,258 | 3 |
| Preston, MD | $169.74 | $7.87 – $172.90 | 5,254 | 3 |
| Cando, ND | $123.16 | $106.58 – $131.88 | 5,252 | 5 |
| Mount Verono, OH | $35.82 | $35.82 – $35.82 | 5,251 | 1 |
| Aurora, NE | $75.95 | $14.17 – $176.19 | 5,249 | 14 |
| Greendale, WI | $31.33 | $18.49 – $84.04 | 5,246 | 8 |
| Maple Shade, NJ | $79.15 | $29.92 – $173.05 | 5,244 | 11 |
| Bear Lake, MI | $62.12 | $62.12 – $62.12 | 5,244 | 1 |
| Fort Eisenhower, GA | $60.48 | $30.77 – $155.84 | 5,241 | 8 |
| Council Grove, KS | $120.47 | $25.17 – $134.61 | 5,238 | 4 |
| Cedar Bluff, AL | $0.80 | $0.00 – $83.55 | 5,234 | 3 |
| De Ruyter, NY | $74.43 | $74.43 – $74.43 | 5,233 | 1 |
| Bridgport, WV | $43.19 | $43.19 – $43.19 | 5,229 | 1 |
| Eton, GA | $45.59 | $29.76 – $61.78 | 5,227 | 2 |
| Union City, GA | $70.03 | $39.33 – $73.18 | 5,224 | 2 |
| Muenster, TX | $76.50 | $72.79 – $166.20 | 5,221 | 4 |
| Woodfin, NC | $47.37 | $47.37 – $47.37 | 5,219 | 1 |
| Okeene, OK | $78.84 | $49.02 – $85.82 | 5,217 | 8 |
| Lake Bluff, IL | $53.65 | $26.05 – $78.73 | 5,214 | 18 |
| Slayton, MN | $95.80 | $32.91 – $154.44 | 5,213 | 7 |
| Fort Stewart, GA | $80.51 | $0.83 – $640.00 | 5,211 | 17 |
| Warfield, KY | $35.90 | $33.80 – $42.05 | 5,203 | 2 |
| Mooreland, OK | $164.78 | $157.87 – $195.48 | 5,200 | 2 |
| White Sulphur Springs, MT | $0.00 | $0.00 – $0.00 | 5,193 | 1 |
| Spring Lake Park, MN | $51.93 | $18.39 – $102.68 | 5,193 | 5 |
| Blackville, SC | $114.73 | $90.17 – $131.38 | 5,192 | 4 |
| Columbus, TX | $27.86 | $11.73 – $95.23 | 5,188 | 8 |
| Monroe, OH | $47.69 | $17.06 – $60.63 | 5,184 | 13 |
| Orange Beach, AL | $14.71 | $0.00 – $81.04 | 5,178 | 6 |
| West Point, NE | $129.90 | $26.44 – $246.71 | 5,177 | 12 |
| Jewett City, CT | $11.47 | $11.47 – $11.47 | 5,176 | 1 |
| Central City, NE | $101.52 | $40.21 – $128.32 | 5,176 | 6 |
| Millstone Township, NJ | $45.69 | $45.69 – $45.69 | 5,174 | 1 |
| Whittier, NC | $182.24 | $34.45 – $233.55 | 5,173 | 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.