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 |
|---|---|---|---|---|
| Ladys Island, SC | $63.69 | $53.76 – $76.59 | 5,171 | 5 |
| Smith River, CA | $24.35 | $24.35 – $24.35 | 5,170 | 1 |
| Overgaard, AZ | $37.66 | $3.00 – $57.74 | 5,170 | 4 |
| Ivoryton, CT | $28.17 | $28.17 – $28.17 | 5,167 | 1 |
| Millbrook, AL | $55.11 | $36.88 – $73.22 | 5,166 | 6 |
| Falfurrias, TX | $28.96 | $26.67 – $163.71 | 5,157 | 3 |
| Montrose, PA | $13.38 | $3.40 – $37.63 | 5,155 | 6 |
| Hartford, AL | $36.95 | $29.44 – $37.00 | 5,151 | 2 |
| East Point, KY | $27.03 | $25.41 – $37.40 | 5,150 | 2 |
| Evart, MI | $7.42 | $0.00 – $8.54 | 5,149 | 3 |
| Brentwood, MD | $49.43 | $49.43 – $49.43 | 5,149 | 1 |
| Beverly, OH | $42.72 | $33.47 – $43.92 | 5,147 | 2 |
| Embudo, NM | $134.41 | $134.41 – $134.41 | 5,144 | 1 |
| Zillah, WA | $53.76 | $43.76 – $100.09 | 5,143 | 5 |
| Puerto Nuevo, PR | $26.85 | $24.99 – $46.13 | 5,143 | 3 |
| Chincoteague Island, VA | $41.69 | $41.55 – $44.88 | 5,142 | 2 |
| Sherman, NY | $73.57 | $68.78 – $76.21 | 5,139 | 2 |
| Britt, IA | $44.68 | $30.49 – $55.38 | 5,138 | 6 |
| South West City, MO | $79.64 | $25.32 – $132.78 | 5,137 | 5 |
| Richmond Hill, GA | $62.31 | $13.60 – $83.00 | 5,136 | 9 |
| Sumiton, AL | $33.87 | $0.00 – $57.23 | 5,135 | 3 |
| Hacienda Hts, CA | $16.27 | $1.21 – $26.06 | 5,135 | 3 |
| Zearing, IA | $23.36 | $16.83 – $35.59 | 5,134 | 2 |
| Bayshore, NY | $86.79 | $20.68 – $168.32 | 5,133 | 8 |
| Bowdle, SD | $59.15 | $31.07 – $93.62 | 5,130 | 3 |
| Depoe Bay, OR | $68.39 | $56.66 – $94.63 | 5,129 | 5 |
| Littcarr, KY | $39.12 | $39.12 – $39.12 | 5,128 | 1 |
| Woodland, MS | $60.00 | $27.67 – $74.84 | 5,120 | 2 |
| Brooklyn Park, MD | $60.34 | $55.65 – $89.19 | 5,120 | 4 |
| Parrottsville, TN | $44.04 | $29.21 – $50.94 | 5,116 | 3 |
| Newberry, FL | $37.40 | $0.00 – $44.20 | 5,113 | 7 |
| Lake Placid, NY | $64.45 | $8.81 – $109.97 | 5,110 | 11 |
| Carrington, ND | $101.88 | $0.00 – $585.12 | 5,108 | 9 |
| Lexington, AL | $29.54 | $29.52 – $29.54 | 5,101 | 2 |
| Canutillo, TX | $73.23 | $39.16 – $100.25 | 5,100 | 2 |
| Greensboro, MD | $169.56 | $166.42 – $170.87 | 5,098 | 3 |
| St Clairsvillle, OH | $28.75 | $28.75 – $28.75 | 5,095 | 1 |
| Mt Vernon, WA | $24.58 | $24.45 – $40.23 | 5,091 | 2 |
| Caquas, PR | $28.42 | $0.00 – $47.51 | 5,087 | 3 |
| Royersford, PA | $48.29 | $0.00 – $69.33 | 5,085 | 11 |
| Heath, TX | $0.01 | $0.01 – $0.01 | 5,083 | 1 |
| Eglin, FL | $54.58 | $54.58 – $54.58 | 5,083 | 1 |
| Leon Valley, TX | $61.95 | $61.95 – $61.95 | 5,080 | 1 |
| Harrison Twp, MI | $56.61 | $56.61 – $56.61 | 5,073 | 1 |
| Iiwaco, WA | $10.89 | $10.89 – $10.89 | 5,072 | 1 |
| Naturita, CO | $104.62 | $66.71 – $251.79 | 5,067 | 7 |
| Wellesley Hills, MA | $45.11 | $4.87 – $121.08 | 5,065 | 10 |
| Big Lake, MN | $74.94 | $61.36 – $90.14 | 5,062 | 4 |
| Lansford, PA | $28.14 | $28.14 – $28.14 | 5,060 | 1 |
| Hopewell Jct, NY | $7.63 | $4.66 – $124.10 | 5,059 | 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.