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 |
|---|---|---|---|---|
| Parks, LA | $16.83 | $16.83 – $16.83 | 2,051 | 1 |
| Elk Creek, VA | $35.20 | $35.20 – $35.20 | 2,051 | 1 |
| Penndel, PA | $67.14 | $7.37 – $67.70 | 2,046 | 2 |
| Salisbury, MO | $94.66 | $90.66 – $140.40 | 2,046 | 4 |
| Fort Hall, ID | $16.30 | $0.00 – $101.95 | 2,043 | 5 |
| North Bay Village, FL | $41.65 | $12.22 – $123.55 | 2,043 | 3 |
| Amagansett, NY | $74.86 | $54.20 – $125.07 | 2,042 | 4 |
| Joshua, TX | $50.34 | $44.92 – $50.53 | 2,041 | 2 |
| Phoenix, NY | $113.83 | $64.68 – $116.27 | 2,040 | 4 |
| Metamora, IL | $54.59 | $39.11 – $72.86 | 2,039 | 4 |
| Hopkinton, IA | $1.88 | $0.00 – $2.52 | 2,037 | 2 |
| Weeping Water, NE | $60.99 | $45.22 – $118.88 | 2,037 | 2 |
| Vernon, NJ | $56.94 | $16.60 – $119.61 | 2,036 | 7 |
| Browns Summit, NC | $43.75 | $40.59 – $54.35 | 2,036 | 3 |
| Pamplico, SC | $49.79 | $49.79 – $49.79 | 2,035 | 1 |
| Alpine, UT | $93.68 | $59.97 – $99.71 | 2,035 | 2 |
| Slate Hill, NY | $75.88 | $75.88 – $75.88 | 2,033 | 1 |
| Estill, SC | $175.26 | $171.23 – $223.42 | 2,033 | 3 |
| Waldron, AR | $65.13 | $27.52 – $77.35 | 2,032 | 3 |
| Gleneden Beach, OR | $48.94 | $48.94 – $48.94 | 2,032 | 1 |
| Port Byron, IL | $43.77 | $43.77 – $43.77 | 2,032 | 1 |
| Hettinger, ND | $68.42 | $45.85 – $144.19 | 2,030 | 9 |
| Barnesville, MN | $46.82 | $46.82 – $46.82 | 2,029 | 1 |
| Pacifica, CA | $15.40 | $13.09 – $22.76 | 2,028 | 3 |
| Philomath, OR | $38.63 | $20.99 – $103.50 | 2,027 | 3 |
| Fowler, MI | $60.46 | $60.46 – $60.46 | 2,026 | 1 |
| Nokomis, IL | $0.17 | $0.17 – $0.17 | 2,026 | 1 |
| Valley Center, KS | $35.26 | $31.53 – $35.31 | 2,026 | 2 |
| Palmyra, NJ | $31.33 | $31.33 – $31.33 | 2,026 | 1 |
| South Williamsport, PA | $49.62 | $47.26 – $50.54 | 2,023 | 2 |
| Elgin, TX | $12.41 | $11.81 – $30.81 | 2,022 | 2 |
| Fonda, NY | $72.43 | $63.99 – $95.24 | 2,021 | 3 |
| Poth, TX | $28.88 | $28.88 – $28.88 | 2,017 | 1 |
| Gower, MO | $63.59 | $55.72 – $76.62 | 2,017 | 2 |
| Johnson, AR | $36.14 | $36.14 – $36.14 | 2,016 | 1 |
| Halifax, MA | $99.26 | $50.62 – $99.55 | 2,015 | 2 |
| Ellinwood, KS | $223.89 | $85.97 – $225.91 | 2,015 | 2 |
| Bald Knob, AR | $15.17 | $0.00 – $24.75 | 2,007 | 6 |
| Brodhead, KY | $38.57 | $24.05 – $39.40 | 2,005 | 2 |
| Conemaugh, PA | $49.42 | $49.42 – $49.42 | 2,004 | 1 |
| Titusville, NJ | $42.29 | $42.29 – $42.29 | 2,003 | 1 |
| Sidney, IA | $0.44 | $0.30 – $11.64 | 2,003 | 2 |
| Oak Hill, VA | $133.01 | $133.01 – $133.01 | 2,000 | 1 |
| Union Grove, WI | $29.00 | $21.37 – $43.47 | 1,998 | 7 |
| Grantsville, UT | $67.31 | $52.09 – $159.88 | 1,997 | 5 |
| Pepperell, MA | $55.65 | $7.44 – $91.29 | 1,995 | 7 |
| Jamestown, RI | $37.26 | $34.32 – $76.61 | 1,993 | 3 |
| Carnation, WA | $44.55 | $44.55 – $44.55 | 1,993 | 1 |
| Minco, OK | $102.38 | $102.38 – $102.38 | 1,992 | 1 |
| Roanoke, TX | $47.74 | $29.91 – $51.52 | 1,990 | 2 |
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.