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 |
|---|---|---|---|---|
| Greenville, DE | $12.70 | $1.02 – $29.04 | 4,216 | 4 |
| Rosenburg, OR | $63.09 | $63.09 – $63.09 | 4,208 | 1 |
| Ford City, PA | $39.13 | $9.98 – $42.76 | 4,205 | 4 |
| Reinholds, PA | $62.81 | $33.68 – $77.06 | 4,203 | 5 |
| Maupin, OR | $84.08 | $13.99 – $96.84 | 4,202 | 2 |
| Ravena, NY | $59.50 | $21.75 – $66.87 | 4,201 | 5 |
| Anna, OH | $37.39 | $36.29 – $41.04 | 4,201 | 4 |
| Santaquin, UT | $59.74 | $10.70 – $77.43 | 4,194 | 7 |
| Brogue, PA | $55.12 | $53.34 – $61.88 | 4,189 | 3 |
| Augusta, AR | $2.04 | $0.19 – $4.35 | 4,188 | 4 |
| Gustine, CA | $3.01 | $2.39 – $4.05 | 4,183 | 2 |
| West Terre Haute, IN | $56.92 | $54.12 – $65.15 | 4,182 | 2 |
| Saluda, VA | $56.29 | $14.12 – $91.17 | 4,180 | 3 |
| Eldridge, IA | $34.48 | $27.36 – $47.87 | 4,178 | 8 |
| Ft Washington, PA | $42.07 | $42.07 – $42.07 | 4,175 | 1 |
| Campbell, MO | $78.51 | $78.51 – $78.51 | 4,175 | 1 |
| Brillion, WI | $34.56 | $31.84 – $59.71 | 4,174 | 5 |
| Mantua, NJ | $46.84 | $46.84 – $46.84 | 4,173 | 1 |
| Aumsville, OR | $38.49 | $35.05 – $124.64 | 4,173 | 5 |
| Wilmington, VT | $26.05 | $22.65 – $34.38 | 4,171 | 2 |
| New Yorl, NY | $71.65 | $71.65 – $71.65 | 4,167 | 1 |
| Vincent, OH | $55.18 | $34.36 – $62.17 | 4,164 | 5 |
| Balsam Lake, WI | $54.20 | $9.16 – $69.22 | 4,163 | 4 |
| Randolph A F B, TX | $54.51 | $33.35 – $54.96 | 4,162 | 2 |
| Shiloh, NJ | $30.77 | $30.77 – $30.77 | 4,161 | 1 |
| Dayton, NJ | $12.23 | $4.94 – $67.07 | 4,158 | 4 |
| Mt Clemens, MI | $56.59 | $56.57 – $63.17 | 4,157 | 2 |
| Itasca, IL | $53.48 | $28.68 – $58.47 | 4,157 | 6 |
| East Long Meadow, MA | $36.10 | $35.61 – $46.77 | 4,155 | 2 |
| Durant, IA | $38.76 | $36.38 – $39.02 | 4,153 | 4 |
| Copan, OK | $89.90 | $89.90 – $89.90 | 4,153 | 1 |
| Jetmore, KS | $169.93 | $134.38 – $231.60 | 4,152 | 2 |
| Lake City, AR | $31.99 | $0.51 – $35.47 | 4,146 | 5 |
| Kamiah, ID | $81.13 | $81.13 – $81.13 | 4,145 | 1 |
| Hillsboro, KS | $114.53 | $0.00 – $219.26 | 4,144 | 4 |
| Saginaw, TX | $42.38 | $2.59 – $78.93 | 4,144 | 9 |
| Winnie, TX | $44.19 | $8.25 – $110.92 | 4,138 | 7 |
| Trion, GA | $41.63 | $32.11 – $53.51 | 4,137 | 4 |
| Milan, IN | $52.18 | $47.49 – $56.22 | 4,137 | 2 |
| Blackshear, GA | $35.98 | $20.53 – $63.09 | 4,136 | 4 |
| Mccamey, TX | $55.68 | $55.68 – $55.68 | 4,130 | 1 |
| North Falmouth, MA | $38.01 | $0.00 – $60.26 | 4,128 | 8 |
| Albion, NE | $109.28 | $16.38 – $154.88 | 4,126 | 9 |
| Sharon, MA | $63.85 | $4.30 – $90.23 | 4,125 | 10 |
| Warsaw, IL | $14.22 | $0.24 – $92.70 | 4,123 | 4 |
| Lomira, WI | $50.99 | $29.57 – $66.11 | 4,119 | 5 |
| Hines, IL | $46.66 | $17.35 – $83.21 | 4,119 | 6 |
| Lake Saint Louis, MO | $59.51 | $36.40 – $92.20 | 4,117 | 9 |
| Ellijay, GA | $47.78 | $23.95 – $68.15 | 4,116 | 6 |
| Southwest Harbor, ME | $36.28 | $21.32 – $48.72 | 4,115 | 12 |
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.