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 |
|---|---|---|---|---|
| Breckenridge, TX | $171.44 | $12.36 – $574.41 | 3,006 | 9 |
| Dora, AL | $48.43 | $34.38 – $76.90 | 3,001 | 7 |
| Bolton, MA | $42.79 | $27.66 – $78.88 | 3,001 | 6 |
| Van Horne, IA | $0.00 | $0.00 – $0.00 | 2,999 | 1 |
| Allenstown, NH | $43.64 | $37.94 – $49.79 | 2,997 | 6 |
| West Alexandria, OH | $62.57 | $62.57 – $62.57 | 2,996 | 1 |
| Silverthorne, CO | $50.74 | $24.95 – $75.82 | 2,995 | 7 |
| Soda Springs, ID | $24.14 | $0.00 – $59.33 | 2,995 | 6 |
| Hampton Falls, NH | $25.84 | $25.84 – $25.84 | 2,993 | 1 |
| Worcester, NY | $33.03 | $32.64 – $90.00 | 2,992 | 3 |
| Epsom, NH | $41.08 | $29.14 – $46.26 | 2,991 | 7 |
| Elk Point, SD | $137.45 | $137.45 – $137.45 | 2,990 | 1 |
| Ship Bottom, NJ | $46.17 | $42.82 – $65.26 | 2,990 | 2 |
| Waseca, MN | $57.58 | $2.17 – $65.27 | 2,990 | 10 |
| Alta Loma, CA | $40.86 | $10.04 – $100.07 | 2,987 | 6 |
| Laurence Harbor, NJ | $60.97 | $60.97 – $60.97 | 2,986 | 1 |
| Oak Creek, CO | $76.70 | $60.62 – $225.68 | 2,986 | 4 |
| Moreland Hills, OH | $29.93 | $29.93 – $29.93 | 2,984 | 1 |
| Silsbee, TX | $30.12 | $22.42 – $105.35 | 2,983 | 6 |
| Sleepy Eye, MN | $173.32 | $169.76 – $174.56 | 2,982 | 4 |
| Rosedale, IN | $53.92 | $53.92 – $53.92 | 2,982 | 1 |
| Atwater, OH | $44.02 | $25.76 – $53.44 | 2,981 | 2 |
| Mclaughlin, SD | $476.87 | $329.62 – $654.00 | 2,976 | 3 |
| Hooker, OK | $93.78 | $93.78 – $93.78 | 2,974 | 1 |
| Slater, MO | $65.40 | $22.91 – $79.58 | 2,972 | 3 |
| Denniston, KY | $39.76 | $39.76 – $39.76 | 2,970 | 1 |
| Harvard, MA | $62.69 | $0.00 – $77.41 | 2,968 | 7 |
| Madison, MN | $177.96 | $40.00 – $196.84 | 2,966 | 7 |
| Benwood, WV | $35.99 | $35.99 – $35.99 | 2,966 | 1 |
| Buckland, AK | $125.91 | $3.74 – $286.78 | 2,965 | 3 |
| Pleasant Hill, MO | $102.12 | $92.73 – $107.11 | 2,962 | 2 |
| Forreston, IL | $48.79 | $48.79 – $48.79 | 2,962 | 1 |
| Ham Lake, MN | $43.74 | $27.80 – $80.94 | 2,962 | 3 |
| Fossil, OR | $53.58 | $4.16 – $64.74 | 2,961 | 5 |
| Ramsey, NJ | $38.64 | $0.00 – $93.53 | 2,961 | 6 |
| Saint Joseph, MN | $57.52 | $55.35 – $65.69 | 2,961 | 5 |
| Girdwood, AK | $251.07 | $70.04 – $331.74 | 2,960 | 5 |
| Lindale, TX | $43.85 | $18.21 – $64.44 | 2,959 | 12 |
| Wabasha, MN | $74.16 | $5.14 – $210.07 | 2,955 | 10 |
| Bethany, CT | $28.69 | $14.50 – $35.39 | 2,955 | 2 |
| Blackduck, MN | $71.13 | $47.57 – $89.19 | 2,953 | 3 |
| Penn Laird, VA | $48.29 | $48.29 – $48.29 | 2,949 | 1 |
| Clyde, TX | $13.52 | $5.31 – $45.22 | 2,944 | 5 |
| Lake Mills, WI | $33.55 | $16.92 – $181.85 | 2,942 | 8 |
| Shreeport, LA | $10.54 | $10.54 – $10.54 | 2,942 | 1 |
| Moline, KS | $126.50 | $126.44 – $129.14 | 2,941 | 2 |
| Highland Hts, OH | $112.87 | $112.87 – $112.87 | 2,939 | 1 |
| Sheffield, OH | $31.45 | $28.02 – $49.68 | 2,934 | 3 |
| Winter Park, CO | $72.26 | $54.83 – $499.02 | 2,933 | 4 |
| Stilwell, KS | $48.18 | $34.72 – $64.40 | 2,931 | 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.