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 |
|---|---|---|---|---|
| Ossian, IN | $66.89 | $57.24 – $75.27 | 3,143 | 3 |
| Richland, IN | $55.93 | $17.73 – $57.85 | 3,143 | 2 |
| Pleasant Hill, IL | $0.00 | $0.00 – $0.00 | 3,141 | 1 |
| Holland, IN | $56.96 | $56.96 – $56.96 | 3,141 | 1 |
| Etna, OH | $46.01 | $41.02 – $63.82 | 3,139 | 3 |
| Patchoque, NY | $95.01 | $95.01 – $95.01 | 3,139 | 1 |
| Remsen, IA | $15.00 | $15.00 – $15.00 | 3,135 | 1 |
| Desplaines, IL | $54.55 | $42.02 – $94.58 | 3,134 | 2 |
| West Pittston, PA | $31.66 | $5.85 – $37.43 | 3,132 | 8 |
| St James, MN | $69.23 | $47.36 – $73.49 | 3,127 | 3 |
| Riverside, NJ | $36.05 | $36.05 – $36.05 | 3,126 | 1 |
| Raphine, VA | $53.02 | $44.97 – $64.55 | 3,122 | 4 |
| Carver, MA | $37.83 | $29.45 – $75.49 | 3,121 | 3 |
| Eielson Afb, AK | $83.61 | $0.00 – $118.92 | 3,121 | 4 |
| Avondale, PA | $57.22 | $0.00 – $58.27 | 3,113 | 2 |
| Carrier Mills, IL | $5.58 | $0.00 – $24.45 | 3,110 | 2 |
| Chepachet, RI | $48.91 | $31.10 – $74.66 | 3,109 | 4 |
| Morro Bay, CA | $26.81 | $14.88 – $37.24 | 3,107 | 5 |
| Sebewaing, MI | $11.75 | $10.07 – $31.62 | 3,107 | 2 |
| Alma, GA | $42.48 | $36.02 – $74.43 | 3,106 | 2 |
| Willard, MO | $82.20 | $30.13 – $98.77 | 3,101 | 6 |
| Upper St Clair, PA | $70.65 | $33.17 – $79.54 | 3,101 | 2 |
| Riviera Beach, FL | $70.42 | $0.00 – $158.50 | 3,101 | 8 |
| Wheatland, WY | $4.93 | $0.00 – $22.22 | 3,100 | 4 |
| Owyhee, NV | $33.30 | $0.00 – $33.80 | 3,097 | 2 |
| De Smet, SD | $96.78 | $39.39 – $121.27 | 3,096 | 2 |
| Romeo, MI | $75.96 | $68.88 – $83.26 | 3,095 | 3 |
| Piedmont, OK | $96.72 | $59.72 – $113.96 | 3,094 | 4 |
| West Helena, AR | $21.17 | $17.26 – $25.30 | 3,093 | 3 |
| Saint George, WV | $0.00 | $0.00 – $0.00 | 3,090 | 1 |
| La Feria, TX | $15.81 | $0.00 – $17.11 | 3,088 | 3 |
| Alton, NH | $44.06 | $35.25 – $47.26 | 3,087 | 3 |
| Mascoutah, IL | $62.50 | $37.65 – $66.10 | 3,085 | 4 |
| Stoneville, NC | $28.48 | $28.48 – $28.48 | 3,084 | 1 |
| Firth, ID | $62.69 | $54.37 – $66.17 | 3,082 | 4 |
| Wildwood Crest, NJ | $33.00 | $31.74 – $33.05 | 3,081 | 2 |
| Orland Hills, IL | $35.69 | $25.52 – $51.93 | 3,080 | 3 |
| Matthews, MO | $18.54 | $18.54 – $18.54 | 3,080 | 1 |
| Malvern, OH | $36.40 | $30.41 – $38.57 | 3,079 | 3 |
| Maize, KS | $57.66 | $57.66 – $57.66 | 3,079 | 1 |
| Coopersburg, PA | $71.61 | $41.72 – $527.75 | 3,076 | 3 |
| Sims, NC | $60.29 | $60.29 – $60.29 | 3,076 | 1 |
| Morena Valley, CA | $6.58 | $6.58 – $6.58 | 3,074 | 1 |
| Folkston, GA | $25.80 | $17.25 – $128.17 | 3,074 | 2 |
| Patterson, NY | $154.28 | $0.00 – $203.92 | 3,074 | 4 |
| Bartonsville, PA | $51.11 | $51.11 – $51.11 | 3,072 | 1 |
| Edna, TX | $40.10 | $28.26 – $125.83 | 3,071 | 4 |
| Lambertville, NJ | $80.60 | $41.95 – $100.77 | 3,070 | 10 |
| Litchfield, MI | $36.06 | $7.18 – $52.93 | 3,070 | 2 |
| Osyka, MS | $37.53 | $37.53 – $37.53 | 3,069 | 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.