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 |
|---|---|---|---|---|
| Pierce City, MO | $1.77 | $0.00 – $1.97 | 1,989 | 2 |
| Bloomfield, KY | $33.47 | $29.16 – $34.53 | 1,988 | 3 |
| To0A Baja, PR | $0.10 | $0.10 – $0.10 | 1,987 | 1 |
| Hudson, CO | $221.56 | $221.56 – $221.56 | 1,986 | 1 |
| Bow, NH | $50.47 | $6.82 – $52.03 | 1,986 | 3 |
| Lacrosse, KS | $119.37 | $119.37 – $119.37 | 1,985 | 1 |
| Pima, AZ | $42.56 | $42.56 – $42.56 | 1,982 | 1 |
| Pillager, MN | $71.59 | $40.99 – $185.32 | 1,979 | 5 |
| Waterloo, WI | $35.32 | $26.00 – $35.99 | 1,979 | 2 |
| Brock, TX | $60.35 | $60.35 – $60.35 | 1,978 | 1 |
| Hinsdale, MT | $118.33 | $118.33 – $118.33 | 1,977 | 1 |
| Erie, IL | $50.67 | $50.67 – $50.67 | 1,976 | 1 |
| Galesville, WI | $38.91 | $14.92 – $41.99 | 1,974 | 3 |
| Kalida, OH | $33.94 | $26.91 – $36.66 | 1,973 | 4 |
| Lanai City, HI | $260.24 | $0.00 – $333.62 | 1,972 | 4 |
| Kent, CT | $57.96 | $0.32 – $66.02 | 1,970 | 4 |
| Silverton, CO | $17.16 | $17.16 – $17.16 | 1,970 | 1 |
| Eldred, PA | $8.41 | $0.39 – $19.69 | 1,970 | 2 |
| Becker, MN | $57.70 | $54.03 – $75.16 | 1,969 | 5 |
| Richfield, OH | $30.07 | $15.25 – $85.50 | 1,969 | 4 |
| Emmitsburg, MD | $81.98 | $27.76 – $136.72 | 1,969 | 7 |
| Au Gres, MI | $16.83 | $16.83 – $16.83 | 1,968 | 1 |
| Princeton, NC | $42.69 | $42.52 – $45.81 | 1,968 | 3 |
| Mt Olive, NC | $25.70 | $4.91 – $54.96 | 1,967 | 2 |
| Orleans, CA | $0.01 | $0.01 – $0.01 | 1,967 | 1 |
| Esopus, NY | $55.84 | $55.84 – $55.84 | 1,967 | 1 |
| Madrid, NY | $53.85 | $0.00 – $55.72 | 1,967 | 2 |
| Waterloo, NE | $13.47 | $4.54 – $52.90 | 1,965 | 2 |
| Ft Pierce, FL | $5.70 | $0.42 – $8.39 | 1,965 | 3 |
| Pioneer, LA | $3.81 | $3.81 – $3.81 | 1,965 | 1 |
| Ave Maria, FL | $27.64 | $25.33 – $42.14 | 1,965 | 4 |
| Beresford, SD | $91.53 | $91.53 – $91.53 | 1,964 | 1 |
| Smithfield, UT | $55.20 | $36.47 – $58.59 | 1,964 | 3 |
| Westwood, CA | $2.69 | $0.81 – $3.21 | 1,964 | 2 |
| Channelview, TX | $44.10 | $13.64 – $141.85 | 1,963 | 3 |
| Nekoosa, WI | $40.10 | $28.07 – $64.19 | 1,963 | 6 |
| Rostraver Township, PA | $28.23 | $7.16 – $130.00 | 1,962 | 13 |
| Barksdale Afb, LA | $43.19 | $0.57 – $119.82 | 1,961 | 8 |
| Woodlyn, PA | $23.42 | $2.08 – $28.31 | 1,961 | 2 |
| Fox River Grove, IL | $65.37 | $62.26 – $78.09 | 1,960 | 4 |
| Marco Island, FL | $56.03 | $55.24 – $61.71 | 1,959 | 2 |
| Lake Junaluska, NC | $60.73 | $60.73 – $60.73 | 1,958 | 1 |
| Star Junction, PA | $46.62 | $46.62 – $46.62 | 1,957 | 1 |
| Hurlburt Field, FL | $97.57 | $0.00 – $514.16 | 1,957 | 6 |
| Nolanville, TX | $46.13 | $46.13 – $46.13 | 1,957 | 1 |
| Snow Camp, NC | $63.11 | $63.11 – $63.11 | 1,956 | 1 |
| Pelzer, SC | $62.06 | $61.95 – $69.23 | 1,953 | 2 |
| New Glarus, WI | $52.45 | $52.45 – $52.45 | 1,953 | 1 |
| Tammpa, FL | $49.29 | $49.29 – $49.29 | 1,951 | 1 |
| Toledo, WA | $21.91 | $21.71 – $22.79 | 1,951 | 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.