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 |
|---|---|---|---|---|
| Grandfield, OK | $59.52 | $56.38 – $91.89 | 4,710 | 3 |
| Hopkinton, NH | $45.82 | $27.55 – $309.19 | 4,710 | 12 |
| The Colony, TX | $44.95 | $8.42 – $115.00 | 4,709 | 5 |
| West Lawn, PA | $93.80 | $80.27 – $96.72 | 4,708 | 3 |
| Fort Meade, MD | $42.03 | $29.35 – $53.48 | 4,707 | 2 |
| Fairlawn, VA | $33.80 | $31.71 – $55.01 | 4,705 | 2 |
| Spring Branch, TX | $45.30 | $0.00 – $230.47 | 4,703 | 4 |
| Tohajiilee, NM | $298.10 | $40.18 – $318.01 | 4,702 | 2 |
| Cosby, TN | $42.33 | $42.33 – $42.33 | 4,701 | 1 |
| Trexlertown, PA | $47.73 | $25.73 – $640.00 | 4,699 | 16 |
| Winchendon, MA | $30.26 | $19.55 – $39.47 | 4,697 | 7 |
| Lapwai, ID | $26.57 | $0.00 – $81.16 | 4,687 | 7 |
| Burnside, KY | $31.23 | $15.73 – $39.46 | 4,687 | 2 |
| Vandergrift, PA | $33.68 | $0.00 – $83.00 | 4,686 | 7 |
| Hesston, KS | $62.91 | $20.37 – $79.80 | 4,683 | 6 |
| Hotchkiss, CO | $116.71 | $15.23 – $167.24 | 4,683 | 4 |
| Haverford, PA | $68.40 | $1.67 – $108.22 | 4,680 | 10 |
| New Johnsonville, TN | $39.00 | $21.11 – $50.57 | 4,673 | 2 |
| W Lancaster, CA | $0.05 | $0.05 – $0.05 | 4,669 | 1 |
| Timpson, TX | $31.31 | $31.31 – $31.31 | 4,663 | 1 |
| Jackson, WI | $29.38 | $28.53 – $49.38 | 4,663 | 6 |
| Hopwood, PA | $44.22 | $31.52 – $53.32 | 4,662 | 5 |
| De Witt, AR | $21.43 | $1.69 – $28.81 | 4,662 | 4 |
| Tacoma Park, MD | $211.34 | $151.76 – $646.65 | 4,660 | 2 |
| Linesville, PA | $1.25 | $0.87 – $41.70 | 4,656 | 2 |
| Saint Francis, KS | $169.87 | $9.24 – $210.33 | 4,655 | 4 |
| Springville, TN | $38.92 | $38.92 – $38.92 | 4,654 | 1 |
| Fort Gaines, GA | $43.81 | $26.06 – $66.30 | 4,654 | 3 |
| Humansville, MO | $97.99 | $48.82 – $101.55 | 4,650 | 3 |
| Mt Mesa, CA | $39.36 | $39.36 – $39.36 | 4,649 | 1 |
| Robeline, LA | $0.06 | $0.06 – $0.06 | 4,648 | 1 |
| Richfield, NC | $53.68 | $49.99 – $62.89 | 4,648 | 3 |
| Holladay, UT | $54.08 | $0.39 – $67.04 | 4,647 | 8 |
| Bethlehem, GA | $60.98 | $36.74 – $113.87 | 4,638 | 4 |
| Woodstock, CT | $40.80 | $0.00 – $42.72 | 4,637 | 2 |
| Youngsville, NC | $40.60 | $15.84 – $75.71 | 4,636 | 5 |
| Chelan Falls, WA | $14.42 | $14.42 – $14.42 | 4,635 | 1 |
| Millstadt, IL | $1.10 | $0.00 – $37.22 | 4,634 | 2 |
| Hill City, KS | $115.10 | $15.58 – $136.95 | 4,634 | 3 |
| Cherryvale, KS | $110.25 | $28.30 – $145.30 | 4,632 | 6 |
| North Carrollton, MS | $40.82 | $18.79 – $51.93 | 4,628 | 3 |
| Mont Vernon, NH | $79.78 | $79.78 – $79.78 | 4,620 | 1 |
| Rios Piedras, PR | $19.26 | $19.26 – $19.26 | 4,619 | 1 |
| Schulenburg, TX | $30.51 | $24.70 – $105.19 | 4,618 | 4 |
| Middlesex, NC | $60.57 | $55.13 – $78.64 | 4,618 | 3 |
| Secane, PA | $18.58 | $6.24 – $21.54 | 4,618 | 3 |
| Pinedale, CA | $42.22 | $0.00 – $56.31 | 4,618 | 2 |
| Dumas, TX | $29.10 | $1.88 – $71.10 | 4,610 | 11 |
| Shamokin Dam, PA | $37.92 | $28.56 – $38.09 | 4,609 | 2 |
| Graettinger, IA | $0.11 | $0.11 – $0.11 | 4,607 | 1 |
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.