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 |
|---|---|---|---|---|
| Flippin, AR | $32.41 | $29.34 – $37.16 | 3,791 | 2 |
| Pinewood, SC | $196.21 | $194.29 – $196.66 | 3,790 | 2 |
| Ft Hood, TX | $88.24 | $46.55 – $654.00 | 3,781 | 3 |
| New Oxford, PA | $41.68 | $12.59 – $64.97 | 3,780 | 12 |
| Whiteman Afb, MO | $57.58 | $44.07 – $84.03 | 3,780 | 4 |
| California, MO | $58.24 | $50.15 – $105.66 | 3,780 | 4 |
| Chesnee, SC | $47.06 | $31.07 – $47.71 | 3,779 | 2 |
| North Liberty, IN | $42.48 | $42.48 – $42.48 | 3,779 | 1 |
| Mcconnelsville, OH | $56.80 | $32.76 – $145.92 | 3,777 | 4 |
| Mound City, MO | $47.89 | $45.06 – $57.82 | 3,777 | 2 |
| Rossville, TN | $18.99 | $18.99 – $18.99 | 3,773 | 1 |
| Bridgeport, CA | $2.56 | $2.31 – $82.07 | 3,773 | 2 |
| Mankato, KS | $102.02 | $102.02 – $102.02 | 3,769 | 1 |
| Veneta, OR | $50.09 | $31.15 – $79.50 | 3,767 | 5 |
| Sugarhill, GA | $30.04 | $21.40 – $51.14 | 3,767 | 3 |
| Halifax, VA | $46.95 | $15.71 – $47.48 | 3,764 | 2 |
| Saint Leonard, MD | $91.36 | $91.36 – $91.36 | 3,764 | 1 |
| St John, VI | $154.14 | $154.14 – $154.14 | 3,760 | 1 |
| Abington, CT | $63.35 | $63.35 – $63.35 | 3,758 | 1 |
| Oberlin, LA | $11.81 | $3.24 – $29.40 | 3,758 | 3 |
| Sweet Water, AL | $8.41 | $8.41 – $8.41 | 3,757 | 1 |
| Chilchinbeto, AZ | $0.02 | $0.02 – $0.02 | 3,757 | 1 |
| East Wareham, MA | $28.18 | $28.15 – $31.56 | 3,756 | 2 |
| Reedsville, WV | $44.75 | $26.63 – $79.15 | 3,754 | 4 |
| Sherman, MS | $49.40 | $19.50 – $66.42 | 3,749 | 3 |
| Eastpoint, FL | $30.24 | $19.05 – $30.35 | 3,748 | 2 |
| Phoenix, NM | $92.84 | $92.84 – $92.84 | 3,748 | 1 |
| Elgin, OK | $116.20 | $0.00 – $176.69 | 3,748 | 5 |
| Suite A, NC | $59.17 | $59.17 – $59.17 | 3,744 | 1 |
| Kenova, WV | $158.84 | $17.53 – $421.80 | 3,741 | 4 |
| Mount Union, PA | $28.19 | $8.73 – $28.44 | 3,731 | 2 |
| Milford, NJ | $77.23 | $59.00 – $81.15 | 3,730 | 11 |
| Brightwaters, NY | $60.33 | $0.00 – $140.99 | 3,728 | 6 |
| West Corina, CA | $32.37 | $32.37 – $32.37 | 3,728 | 1 |
| Laurel, NE | $60.36 | $60.36 – $60.36 | 3,727 | 1 |
| Emory, VA | $56.99 | $55.74 – $59.60 | 3,726 | 2 |
| Waterman, IL | $58.06 | $54.54 – $64.97 | 3,725 | 2 |
| Camanche, IA | $46.61 | $46.61 – $46.61 | 3,722 | 1 |
| Le Grand, CA | $11.77 | $0.00 – $12.00 | 3,721 | 2 |
| Paulsboro, NJ | $37.61 | $0.00 – $39.54 | 3,721 | 4 |
| Roderfield, WV | $50.21 | $43.38 – $58.86 | 3,721 | 2 |
| Latham, OH | $46.29 | $46.29 – $46.29 | 3,718 | 1 |
| Germatown, TN | $34.66 | $34.66 – $34.66 | 3,716 | 1 |
| Long Beach, IN | $59.87 | $59.87 – $59.87 | 3,714 | 1 |
| Oakwood, VA | $35.41 | $14.98 – $53.25 | 3,708 | 3 |
| Napakiak, AK | $356.74 | $343.79 – $433.49 | 3,699 | 2 |
| Oracle, AZ | $44.37 | $2.36 – $108.96 | 3,698 | 4 |
| Winthrop, IA | $4.35 | $0.00 – $36.08 | 3,692 | 3 |
| Mendon, MA | $52.51 | $29.40 – $81.50 | 3,691 | 7 |
| Rockwood, TN | $26.41 | $12.55 – $48.79 | 3,691 | 5 |
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.