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 |
|---|---|---|---|---|
| Clay City, IN | $52.22 | $51.26 – $55.41 | 3,960 | 2 |
| Cornwall On Hudson, NY | $101.95 | $101.95 – $101.95 | 3,959 | 1 |
| Miller, SD | $232.10 | $12.12 – $392.02 | 3,958 | 3 |
| Beaver, OK | $135.24 | $107.46 – $217.20 | 3,957 | 7 |
| Greenup, IL | $6.01 | $0.00 – $23.36 | 3,956 | 2 |
| Oakville, CT | $20.96 | $0.63 – $55.53 | 3,955 | 3 |
| Windsor Locks, CT | $50.00 | $27.95 – $51.30 | 3,950 | 3 |
| Plumsteadville, PA | $35.73 | $33.15 – $36.94 | 3,948 | 4 |
| Pinetop, AZ | $55.77 | $55.77 – $55.77 | 3,947 | 1 |
| Duvall, WA | $51.36 | $45.71 – $56.08 | 3,946 | 6 |
| Grandview, MO | $65.17 | $12.40 – $76.91 | 3,944 | 7 |
| Marion, NY | $74.44 | $39.98 – $93.17 | 3,940 | 6 |
| Spring Valley, MN | $61.34 | $56.42 – $61.71 | 3,939 | 2 |
| Hyndman, PA | $13.29 | $0.00 – $49.98 | 3,939 | 8 |
| Seymour, WI | $32.01 | $20.35 – $65.21 | 3,938 | 7 |
| Marblehead, MA | $55.36 | $0.00 – $78.42 | 3,935 | 16 |
| Hartford, VT | $14.70 | $1.65 – $38.54 | 3,932 | 6 |
| Oak Island, NC | $61.47 | $47.38 – $65.80 | 3,932 | 7 |
| Grainte, OK | $54.35 | $54.35 – $54.35 | 3,932 | 1 |
| Livermore, KY | $39.33 | $39.33 – $39.33 | 3,931 | 1 |
| Harrisville, UT | $58.75 | $4.59 – $75.74 | 3,930 | 4 |
| Reeds Spring, MO | $16.73 | $16.73 – $16.73 | 3,928 | 1 |
| Calmar, IA | $33.36 | $26.82 – $35.84 | 3,926 | 3 |
| Friendship, TN | $48.94 | $39.18 – $51.85 | 3,925 | 2 |
| Oil City, LA | $32.63 | $29.04 – $33.78 | 3,924 | 2 |
| Albion, PA | $40.62 | $35.57 – $64.13 | 3,922 | 4 |
| Moundsvillle, WV | $57.89 | $57.89 – $57.89 | 3,922 | 1 |
| Turners Falls, MA | $46.26 | $28.06 – $60.81 | 3,918 | 8 |
| Fairfax, VT | $23.39 | $0.03 – $104.76 | 3,913 | 7 |
| Fort Moore, GA | $56.57 | $53.20 – $61.68 | 3,910 | 4 |
| Rockledge, PA | $48.65 | $8.21 – $78.29 | 3,909 | 7 |
| Crete, IL | $29.72 | $29.72 – $29.72 | 3,909 | 1 |
| Schofield, WI | $33.62 | $5.48 – $47.95 | 3,904 | 6 |
| Norwood, NC | $54.30 | $52.05 – $58.94 | 3,901 | 2 |
| Upper Chichester, PA | $36.68 | $36.68 – $36.68 | 3,900 | 1 |
| Cliffisde Park, NJ | $46.14 | $46.14 – $46.14 | 3,899 | 1 |
| Parkers Prairie, MN | $60.30 | $30.67 – $63.69 | 3,899 | 4 |
| Dalton, MA | $28.80 | $5.04 – $61.08 | 3,898 | 4 |
| Woodstock, MD | $106.15 | $106.15 – $106.15 | 3,898 | 1 |
| Ada, MI | $60.10 | $58.02 – $83.05 | 3,897 | 3 |
| New Haven, WV | $59.13 | $59.13 – $59.13 | 3,889 | 1 |
| Wakeeney, KS | $104.68 | $0.00 – $118.65 | 3,889 | 2 |
| Bartonville, IL | $49.99 | $44.20 – $60.33 | 3,889 | 4 |
| Pembroke Pnes, FL | $37.22 | $37.22 – $37.22 | 3,889 | 1 |
| Lee, ME | $1.33 | $1.33 – $1.33 | 3,888 | 1 |
| Oswego, KS | $69.20 | $17.54 – $150.56 | 3,887 | 6 |
| Ingleside, IL | $64.01 | $39.12 – $78.42 | 3,887 | 2 |
| Hazlehurst, GA | $49.29 | $27.93 – $91.29 | 3,885 | 5 |
| Dundee, MI | $67.44 | $67.44 – $67.44 | 3,881 | 1 |
| Northvale, NJ | $81.02 | $11.78 – $89.68 | 3,881 | 3 |
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.