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 |
|---|---|---|---|---|
| Cedar Hill, MO | $53.55 | $47.39 – $79.15 | 2,929 | 7 |
| Tutwiler, MS | $49.04 | $27.39 – $71.85 | 2,927 | 2 |
| Mediapolis, IA | $0.02 | $0.00 – $0.05 | 2,926 | 2 |
| Warr Acres, OK | $158.22 | $71.82 – $418.22 | 2,922 | 5 |
| Sinking Spring, PA | $48.82 | $35.51 – $104.07 | 2,921 | 4 |
| W Bloomfield, MI | $53.18 | $47.75 – $73.12 | 2,920 | 3 |
| Glen St Mary, FL | $42.01 | $42.01 – $42.01 | 2,920 | 1 |
| Dover, PA | $49.94 | $27.31 – $59.51 | 2,920 | 5 |
| Schuylkill Haven, PA | $38.17 | $31.61 – $52.21 | 2,920 | 2 |
| North Wales, PA | $26.11 | $2.95 – $37.30 | 2,916 | 6 |
| Fort Meade, SD | $129.74 | $19.72 – $426.75 | 2,916 | 3 |
| Mayfield, NY | $72.30 | $29.87 – $93.57 | 2,915 | 8 |
| Clarence, MO | $53.74 | $44.95 – $63.24 | 2,914 | 4 |
| Dunbar, WV | $31.85 | $0.31 – $65.02 | 2,913 | 7 |
| New Athens, IL | $62.80 | $62.80 – $62.80 | 2,911 | 1 |
| Roebling, NJ | $44.51 | $44.51 – $44.51 | 2,908 | 1 |
| Burnsville, WV | $7.66 | $0.00 – $8.01 | 2,908 | 2 |
| Tremont, MS | $105.14 | $21.07 – $123.32 | 2,906 | 5 |
| Altamont, KS | $127.34 | $21.20 – $135.41 | 2,904 | 3 |
| Wolfforth, TX | $44.32 | $22.02 – $53.92 | 2,903 | 5 |
| Gowanda, NY | $149.13 | $32.04 – $196.23 | 2,900 | 8 |
| Montgomeryville, PA | $37.21 | $0.00 – $95.67 | 2,897 | 5 |
| Lamar, AR | $32.34 | $13.68 – $36.45 | 2,896 | 4 |
| Cabool, MO | $65.85 | $65.83 – $68.79 | 2,893 | 2 |
| Cuyahoga, OH | $44.46 | $44.46 – $44.46 | 2,893 | 1 |
| Carlyle, IL | $10.95 | $0.00 – $37.00 | 2,893 | 6 |
| Erath, LA | $14.45 | $0.00 – $29.82 | 2,893 | 2 |
| Callahan, FL | $34.64 | $0.00 – $79.44 | 2,891 | 12 |
| Trumball, CT | $22.27 | $22.27 – $22.27 | 2,890 | 1 |
| Vandenberg Afb, CA | $2.00 | $2.00 – $2.00 | 2,889 | 1 |
| Forestville, NY | $33.11 | $33.11 – $33.11 | 2,888 | 1 |
| Gearhart, OR | $45.99 | $38.50 – $46.18 | 2,887 | 2 |
| Salisbury, MA | $47.78 | $30.36 – $55.48 | 2,886 | 2 |
| Meredith, NH | $43.70 | $26.97 – $62.43 | 2,886 | 5 |
| Walkerton, IN | $69.45 | $69.45 – $69.45 | 2,884 | 1 |
| Denver, IA | $19.35 | $0.00 – $30.49 | 2,883 | 3 |
| Cagnas, PR | $4.92 | $4.92 – $4.92 | 2,883 | 1 |
| Ashland, CA | $67.65 | $67.65 – $67.65 | 2,882 | 1 |
| Bloomfield, NE | $26.74 | $14.79 – $68.53 | 2,879 | 3 |
| Teaticket, MA | $26.26 | $13.65 – $53.61 | 2,876 | 3 |
| Boulder, MT | $52.57 | $0.00 – $123.58 | 2,874 | 7 |
| Captain Cook, HI | $100.39 | $62.82 – $110.89 | 2,872 | 2 |
| Glenmont, NY | $85.70 | $63.20 – $96.80 | 2,869 | 5 |
| Orange, MA | $24.68 | $5.38 – $66.43 | 2,869 | 5 |
| Guilderland, NY | $62.58 | $33.04 – $68.45 | 2,868 | 5 |
| Cannelton, IN | $9.29 | $9.29 – $9.29 | 2,867 | 1 |
| Brewerton, NY | $40.34 | $40.34 – $40.34 | 2,866 | 1 |
| Milan, IL | $43.09 | $40.77 – $71.99 | 2,864 | 2 |
| Dalhart, TX | $35.86 | $9.53 – $196.35 | 2,864 | 7 |
| Coalville, UT | $55.60 | $52.54 – $60.88 | 2,862 | 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.