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 |
|---|---|---|---|---|
| Mercersburg, PA | $27.14 | $0.86 – $46.02 | 4,818 | 6 |
| Louisiana, MO | $86.67 | $39.98 – $94.28 | 4,818 | 6 |
| Clairfield, TN | $39.99 | $39.99 – $39.99 | 4,818 | 1 |
| Sacramento, KY | $20.80 | $14.80 – $20.82 | 4,817 | 2 |
| Zimmerman, MN | $73.00 | $32.58 – $84.08 | 4,809 | 6 |
| Mondovi, WI | $34.53 | $12.76 – $62.18 | 4,806 | 11 |
| Rockdale, TX | $33.24 | $8.28 – $37.75 | 4,804 | 4 |
| Woodhull, NY | $45.43 | $45.43 – $45.43 | 4,804 | 1 |
| Howard, OH | $110.94 | $107.04 – $121.16 | 4,802 | 2 |
| Cottonwood Heights, UT | $24.85 | $9.67 – $93.07 | 4,802 | 10 |
| Port Sanilac, MI | $1.08 | $1.08 – $1.08 | 4,801 | 1 |
| Crum Lynne, PA | $15.45 | $0.00 – $37.32 | 4,800 | 6 |
| Carrabelle, FL | $52.47 | $12.09 – $54.23 | 4,799 | 3 |
| Grosse Pointe Farms, MI | $53.71 | $32.85 – $66.30 | 4,797 | 7 |
| Minonk, IL | $34.61 | $0.00 – $55.64 | 4,796 | 3 |
| Lyndonville, VT | $10.75 | $6.74 – $16.03 | 4,794 | 3 |
| Sturgis, KY | $35.85 | $25.13 – $38.13 | 4,791 | 3 |
| Earlimart, CA | $5.65 | $2.11 – $24.47 | 4,787 | 4 |
| Middleville, MI | $10.75 | $5.38 – $72.94 | 4,786 | 2 |
| Jeffersonville, KY | $71.54 | $71.54 – $71.54 | 4,784 | 1 |
| Dexter, NM | $52.59 | $47.63 – $60.68 | 4,783 | 2 |
| Salem, NY | $62.01 | $41.72 – $63.77 | 4,783 | 2 |
| Seeley Lake, MT | $0.00 | $0.00 – $0.00 | 4,780 | 1 |
| Brookyln, NY | $88.77 | $87.60 – $94.82 | 4,777 | 2 |
| Dunlap, IA | $0.01 | $0.00 – $0.02 | 4,776 | 2 |
| Munroe Falls, OH | $56.93 | $23.35 – $71.27 | 4,769 | 2 |
| Beggs, OK | $38.63 | $38.63 – $38.63 | 4,765 | 1 |
| East Carbon, UT | $17.16 | $2.02 – $96.78 | 4,761 | 3 |
| Teutopolis, IL | $4.40 | $0.00 – $36.70 | 4,758 | 4 |
| Fanwood, NJ | $21.35 | $9.01 – $63.29 | 4,756 | 4 |
| Jacksonville, OR | $76.36 | $76.04 – $90.49 | 4,755 | 2 |
| Marlow, OK | $70.38 | $0.00 – $161.29 | 4,753 | 4 |
| Mattituck, NY | $78.12 | $62.53 – $136.82 | 4,751 | 5 |
| Danville, WV | $4.83 | $0.39 – $18.84 | 4,749 | 3 |
| Hollis Hills, NY | $61.49 | $35.26 – $123.56 | 4,747 | 2 |
| Phx, AZ | $47.82 | $47.70 – $61.86 | 4,745 | 2 |
| Sugarland, TX | $29.52 | $16.46 – $31.15 | 4,741 | 3 |
| Burnet, TX | $77.82 | $0.00 – $201.11 | 4,737 | 11 |
| Cola, SC | $12.52 | $12.52 – $12.52 | 4,735 | 1 |
| Flanders, NJ | $58.19 | $2.75 – $78.48 | 4,734 | 6 |
| Correctionville, IA | $6.90 | $4.77 – $13.97 | 4,728 | 2 |
| Melrose, FL | $55.77 | $30.48 – $114.46 | 4,724 | 4 |
| Marietta, MS | $55.35 | $50.82 – $58.40 | 4,720 | 2 |
| Charlotte Courthouse, VA | $33.42 | $31.81 – $44.97 | 4,718 | 2 |
| Hopkins Park, IL | $53.68 | $0.00 – $56.81 | 4,716 | 2 |
| Provincetown, MA | $40.76 | $3.66 – $77.46 | 4,715 | 8 |
| Saint Helen, MI | $45.44 | $35.99 – $52.81 | 4,714 | 2 |
| Pennsburg, PA | $44.29 | $24.08 – $53.52 | 4,714 | 9 |
| Sandoval, IL | $45.54 | $45.54 – $45.54 | 4,712 | 1 |
| Bonner Springs, KS | $42.12 | $23.64 – $46.99 | 4,712 | 4 |
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.