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 |
|---|---|---|---|---|
| Celina, TX | $59.30 | $0.00 – $112.52 | 3,069 | 6 |
| Pomeroy, WA | $50.13 | $24.10 – $64.38 | 3,068 | 4 |
| Pollock Pines, CA | $25.66 | $25.66 – $25.66 | 3,066 | 1 |
| Geneva, IN | $66.16 | $66.16 – $66.16 | 3,064 | 1 |
| East Troy, WI | $37.13 | $29.35 – $400.00 | 3,063 | 7 |
| Swayzee, IN | $51.60 | $51.60 – $51.60 | 3,063 | 1 |
| Tchula, MS | $53.46 | $17.34 – $93.26 | 3,063 | 2 |
| Burnham, PA | $41.02 | $37.99 – $44.39 | 3,062 | 3 |
| Chester, WV | $96.49 | $46.44 – $105.66 | 3,060 | 3 |
| Barnhart, MO | $55.51 | $28.23 – $105.17 | 3,059 | 7 |
| Benbrook, TX | $84.45 | $33.81 – $118.89 | 3,058 | 4 |
| Monrovia, IN | $92.58 | $92.58 – $92.58 | 3,057 | 1 |
| Telluride, CO | $60.66 | $57.49 – $62.46 | 3,057 | 5 |
| Huntington, TX | $25.99 | $23.80 – $31.39 | 3,057 | 2 |
| Idalou, TX | $44.80 | $43.47 – $44.89 | 3,056 | 2 |
| Mayfield, OH | $52.71 | $47.42 – $54.03 | 3,056 | 2 |
| Camden, MS | $52.93 | $52.93 – $52.93 | 3,056 | 1 |
| Prospect, TN | $33.58 | $33.58 – $33.58 | 3,056 | 1 |
| Spring Green, WI | $24.18 | $19.28 – $55.09 | 3,053 | 5 |
| Springfield, MN | $62.93 | $31.46 – $79.33 | 3,051 | 7 |
| Lanark, IL | $50.23 | $50.23 – $50.23 | 3,051 | 1 |
| Raymond, MS | $41.00 | $37.44 – $56.20 | 3,049 | 2 |
| Downington, PA | $48.89 | $48.89 – $48.89 | 3,049 | 1 |
| Limestone, TN | $31.45 | $31.03 – $39.94 | 3,047 | 3 |
| Turbeville, SC | $54.79 | $54.79 – $54.79 | 3,046 | 1 |
| Pacific, MO | $61.11 | $60.77 – $99.01 | 3,044 | 2 |
| Stanberry, MO | $74.41 | $16.80 – $113.91 | 3,043 | 5 |
| Ashland, ME | $3.43 | $3.43 – $3.43 | 3,043 | 1 |
| Holly Hill, FL | $42.72 | $42.48 – $42.73 | 3,043 | 2 |
| Fruit St, MA | $35.68 | $35.68 – $35.68 | 3,042 | 1 |
| Snyder, NY | $67.11 | $45.56 – $68.25 | 3,039 | 3 |
| Bethel, OK | $638.09 | $638.09 – $638.09 | 3,038 | 1 |
| Camden, ME | $60.16 | $32.39 – $70.38 | 3,037 | 3 |
| Philadephia, PA | $70.73 | $70.73 – $70.73 | 3,036 | 1 |
| Anthon, IA | $9.52 | $5.62 – $18.29 | 3,036 | 2 |
| Camden, NC | $43.53 | $19.82 – $46.24 | 3,036 | 4 |
| Holstein, IA | $0.45 | $0.18 – $1.99 | 3,034 | 2 |
| St Peter, MN | $68.69 | $34.79 – $70.07 | 3,032 | 4 |
| Blue Mountain, MS | $76.14 | $12.60 – $78.01 | 3,030 | 3 |
| Lafayette, AL | $47.84 | $36.65 – $53.04 | 3,029 | 2 |
| Benkelman, NE | $74.03 | $19.03 – $131.74 | 3,028 | 9 |
| Peshastin, WA | $51.13 | $49.56 – $56.95 | 3,028 | 3 |
| Manhasset Hills, NY | $54.12 | $9.55 – $86.79 | 3,021 | 4 |
| Cameron, WV | $55.19 | $52.87 – $60.07 | 3,016 | 2 |
| Max Meadows, VA | $63.26 | $23.40 – $73.49 | 3,013 | 3 |
| Milford, PA | $64.56 | $19.13 – $87.36 | 3,010 | 6 |
| Weldon Spring, MO | $40.83 | $0.81 – $116.52 | 3,009 | 3 |
| Kiowa, KS | $173.34 | $173.34 – $173.34 | 3,008 | 1 |
| Annawan, IL | $7.78 | $0.33 – $30.56 | 3,008 | 2 |
| Suffern, NJ | $72.19 | $72.19 – $72.19 | 3,006 | 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.