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 |
|---|---|---|---|---|
| Granite Falls, WA | $51.72 | $46.23 – $52.76 | 4,036 | 3 |
| Panora, IA | $4.39 | $0.00 – $18.81 | 4,035 | 3 |
| Lyme, NH | $48.17 | $0.00 – $71.64 | 4,035 | 4 |
| Notasulga, AL | $35.18 | $35.18 – $35.18 | 4,035 | 1 |
| Dewitt, NY | $93.34 | $91.36 – $94.04 | 4,032 | 2 |
| Clayton, NY | $44.12 | $38.69 – $49.56 | 4,024 | 6 |
| Grandview, OH | $52.84 | $36.29 – $70.80 | 4,023 | 3 |
| Newark Valley, NY | $67.88 | $66.17 – $69.12 | 4,017 | 2 |
| Girard, KS | $124.33 | $24.13 – $124.99 | 4,013 | 3 |
| Marionville, MO | $66.68 | $58.46 – $91.02 | 4,012 | 2 |
| Leechburg, PA | $33.56 | $0.00 – $51.36 | 4,011 | 7 |
| Northford, CT | $19.29 | $0.00 – $43.11 | 4,011 | 2 |
| Roberta, GA | $110.48 | $33.37 – $115.28 | 4,009 | 2 |
| Hamilton, IL | $2.37 | $0.97 – $32.60 | 4,009 | 2 |
| Fort Supply, OK | $64.24 | $64.24 – $64.24 | 4,009 | 1 |
| Fairless Hills, PA | $17.29 | $0.00 – $64.62 | 4,008 | 9 |
| Garrochales, PR | $0.78 | $0.78 – $0.78 | 4,008 | 1 |
| Frankton, IN | $45.44 | $45.44 – $45.44 | 4,007 | 1 |
| Utica, KY | $32.72 | $32.71 – $35.49 | 4,007 | 2 |
| Grant, NE | $83.42 | $22.91 – $132.61 | 4,007 | 11 |
| North Fort Myers, FL | $36.41 | $1.75 – $68.74 | 4,006 | 9 |
| Castleton, IN | $43.15 | $43.15 – $43.15 | 4,005 | 1 |
| Stewartville, MN | $41.07 | $6.52 – $53.79 | 4,004 | 6 |
| Woodsboro, MD | $44.37 | $0.00 – $100.31 | 4,003 | 6 |
| Hatteras, NC | $73.51 | $57.64 – $76.97 | 4,001 | 2 |
| Castlewood, VA | $46.73 | $33.30 – $47.20 | 4,001 | 2 |
| Dublin, PA | $49.28 | $26.36 – $50.82 | 3,997 | 2 |
| Headland, AL | $69.25 | $24.96 – $193.42 | 3,997 | 3 |
| Duncan, AZ | $0.01 | $0.01 – $0.01 | 3,994 | 1 |
| Killingworth, CT | $53.92 | $23.61 – $54.41 | 3,992 | 3 |
| Mount Carroll, IL | $29.63 | $11.76 – $41.18 | 3,992 | 2 |
| Canby, CA | $3.01 | $0.19 – $4.58 | 3,988 | 4 |
| Devon, PA | $16.40 | $0.00 – $194.56 | 3,988 | 6 |
| Lake City, MI | $40.20 | $37.52 – $59.74 | 3,987 | 2 |
| Cathlamet, WA | $30.55 | $0.00 – $33.55 | 3,987 | 3 |
| Taylor, TX | $26.40 | $8.30 – $117.39 | 3,984 | 10 |
| Henderson, LA | $22.08 | $22.08 – $22.08 | 3,981 | 1 |
| Burlington, WA | $47.00 | $31.06 – $79.09 | 3,976 | 6 |
| Weldon, NC | $44.30 | $44.30 – $44.30 | 3,973 | 1 |
| Elmira, MI | $14.69 | $14.69 – $14.69 | 3,972 | 1 |
| Letcher, KY | $38.12 | $38.12 – $38.12 | 3,972 | 1 |
| Cookson, OK | $34.94 | $20.36 – $50.81 | 3,972 | 3 |
| Wittmann, AZ | $69.50 | $2.51 – $195.28 | 3,971 | 3 |
| Fort Lee, VA | $57.62 | $20.20 – $67.48 | 3,968 | 5 |
| Albany, MN | $77.98 | $56.61 – $136.30 | 3,968 | 9 |
| Lamesa, TX | $118.05 | $18.33 – $215.02 | 3,965 | 5 |
| Reedsville, WI | $29.42 | $29.42 – $29.42 | 3,964 | 1 |
| Kermit, WV | $23.48 | $12.85 – $40.17 | 3,964 | 2 |
| Corinth, TX | $27.57 | $9.07 – $28.55 | 3,963 | 3 |
| Mount Holly Springs, PA | $40.19 | $40.19 – $40.19 | 3,962 | 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.