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 |
|---|---|---|---|---|
| Olmsted Falls, OH | $54.45 | $16.90 – $86.94 | 2,862 | 5 |
| Big Lake, AK | $160.00 | $85.64 – $182.69 | 2,861 | 2 |
| Rochester, IL | $56.07 | $37.21 – $70.90 | 2,861 | 5 |
| Clear Lake, SD | $126.50 | $28.08 – $190.37 | 2,861 | 4 |
| Pottsville, AR | $39.00 | $25.87 – $39.43 | 2,859 | 2 |
| Encintas, CA | $6.14 | $6.14 – $6.14 | 2,859 | 1 |
| Strausstown, PA | $76.65 | $41.84 – $77.16 | 2,857 | 2 |
| Mcgaheysville, VA | $60.91 | $60.91 – $60.91 | 2,857 | 1 |
| Palmer Lake, CO | $113.93 | $113.93 – $113.93 | 2,855 | 1 |
| Newton Grove, NC | $43.98 | $37.51 – $75.93 | 2,855 | 2 |
| Abiquiu, NM | $12.14 | $12.14 – $12.14 | 2,851 | 1 |
| River Rouge, MI | $49.60 | $49.60 – $49.60 | 2,851 | 1 |
| Fincastle, VA | $47.78 | $17.20 – $50.42 | 2,849 | 3 |
| Orcovis, PR | $0.95 | $0.95 – $0.95 | 2,849 | 1 |
| Ojo Caliente, NM | $16.54 | $14.80 – $54.98 | 2,849 | 2 |
| Peotone, IL | $3.34 | $3.34 – $3.34 | 2,848 | 1 |
| Crested Butte, CO | $79.49 | $48.74 – $102.78 | 2,841 | 4 |
| Sanger, TX | $34.42 | $34.42 – $34.42 | 2,841 | 1 |
| Lake Winola, PA | $42.84 | $42.84 – $42.84 | 2,841 | 1 |
| Aurora, NC | $55.51 | $55.51 – $55.51 | 2,840 | 1 |
| Beulah, ND | $239.34 | $65.82 – $317.17 | 2,838 | 12 |
| Atkinson, NE | $72.86 | $20.31 – $210.17 | 2,836 | 7 |
| Keesler Afb, MS | $101.49 | $3.72 – $130.30 | 2,834 | 6 |
| Shinglehouse, PA | $6.15 | $0.00 – $46.52 | 2,832 | 3 |
| Seymour, TX | $20.74 | $17.63 – $37.64 | 2,832 | 4 |
| Sonora, TX | $49.09 | $12.04 – $50.00 | 2,831 | 3 |
| Suite 228, CA | $13.42 | $13.42 – $13.42 | 2,827 | 1 |
| Sylvan Lake, MI | $60.65 | $29.10 – $61.76 | 2,825 | 2 |
| Brighton, IL | $107.46 | $107.46 – $107.46 | 2,825 | 1 |
| Ness City, KS | $104.62 | $32.77 – $136.15 | 2,824 | 3 |
| West Point, IA | $34.32 | $34.32 – $34.32 | 2,824 | 1 |
| E Waterboro, ME | $72.47 | $72.47 – $72.47 | 2,819 | 1 |
| La Farge, WI | $45.63 | $22.53 – $60.57 | 2,819 | 5 |
| Plymouth, CA | $34.55 | $34.55 – $34.55 | 2,818 | 1 |
| Tracy City, TN | $24.49 | $19.19 – $26.38 | 2,818 | 2 |
| Colfax, NC | $55.07 | $53.43 – $55.13 | 2,818 | 2 |
| Whitehall, NY | $85.40 | $85.40 – $85.40 | 2,817 | 1 |
| Elizabeth, PA | $43.35 | $32.80 – $47.07 | 2,815 | 4 |
| Bogart, GA | $8.32 | $0.00 – $8.39 | 2,815 | 2 |
| Bonham, TX | $345.60 | $0.00 – $535.90 | 2,815 | 9 |
| Stafford, KS | $85.46 | $48.23 – $199.60 | 2,814 | 3 |
| Brockway, MI | $61.80 | $61.80 – $61.80 | 2,810 | 1 |
| Broad Top, PA | $4.13 | $2.66 – $23.52 | 2,808 | 2 |
| Vernon, FL | $51.33 | $51.33 – $51.33 | 2,807 | 1 |
| Elephant Butte, NM | $63.05 | $63.05 – $63.05 | 2,806 | 1 |
| Creswell, OR | $72.82 | $46.03 – $74.96 | 2,803 | 4 |
| Redstone Arsenal, AL | $60.68 | $60.68 – $60.68 | 2,803 | 1 |
| West Trenton, NJ | $36.15 | $36.15 – $36.15 | 2,802 | 1 |
| San Augustine, TX | $28.80 | $27.01 – $34.50 | 2,801 | 6 |
| Waddy, KY | $30.69 | $30.69 – $30.69 | 2,801 | 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.