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 |
|---|---|---|---|---|
| Cuyahogo Falls, OH | $48.50 | $48.50 – $48.50 | 1,838 | 1 |
| Grand Rivers, KY | $31.85 | $31.61 – $34.82 | 1,838 | 2 |
| Wishek, ND | $82.71 | $28.25 – $135.45 | 1,838 | 7 |
| Alamo Heights, TX | $35.42 | $35.26 – $36.44 | 1,836 | 2 |
| Mt. Kisco, NY | $130.01 | $130.01 – $130.01 | 1,835 | 1 |
| Aberdeen, ID | $3.98 | $3.32 – $4.23 | 1,835 | 2 |
| Bedminster, NJ | $64.58 | $59.85 – $65.71 | 1,835 | 2 |
| Big Lake, TX | $21.68 | $10.53 – $21.87 | 1,834 | 2 |
| Keota, IA | $33.41 | $33.41 – $33.41 | 1,833 | 1 |
| Ithica, NY | $84.68 | $84.68 – $84.68 | 1,832 | 1 |
| Delavan, IL | $51.93 | $47.63 – $318.75 | 1,831 | 2 |
| Riceville, TN | $37.71 | $37.71 – $37.71 | 1,831 | 1 |
| Nashua, IA | $3.28 | $0.00 – $6.87 | 1,830 | 3 |
| Randolph, UT | $132.69 | $132.69 – $132.69 | 1,826 | 1 |
| Paris, AR | $29.10 | $23.57 – $42.09 | 1,824 | 3 |
| Lords Valley, PA | $21.48 | $2.02 – $59.17 | 1,824 | 2 |
| Scottsville, VA | $45.30 | $38.75 – $49.65 | 1,822 | 2 |
| Cheney, KS | $37.92 | $37.17 – $39.02 | 1,822 | 3 |
| Greeleyville, SC | $137.91 | $137.91 – $137.91 | 1,820 | 1 |
| Halifax, NC | $38.97 | $31.96 – $56.49 | 1,819 | 2 |
| Winona, MO | $104.74 | $85.59 – $110.71 | 1,818 | 2 |
| Sycamore, SC | $42.85 | $42.85 – $42.85 | 1,817 | 1 |
| W Hempstead, NY | $41.51 | $39.78 – $94.75 | 1,816 | 3 |
| Orient, OH | $43.47 | $34.73 – $49.91 | 1,816 | 3 |
| Halfway, OR | $204.73 | $60.20 – $263.30 | 1,816 | 3 |
| Elcho, WI | $54.43 | $46.45 – $55.97 | 1,814 | 3 |
| North Scituate, RI | $69.99 | $69.99 – $69.99 | 1,813 | 1 |
| Joint Base Andrews, MD | $131.17 | $131.17 – $131.17 | 1,812 | 1 |
| Gladewater, TX | $40.99 | $38.45 – $48.43 | 1,812 | 2 |
| Lolo, MT | $76.11 | $76.11 – $76.11 | 1,811 | 1 |
| North Plains, OR | $68.40 | $68.40 – $68.40 | 1,810 | 1 |
| Southboro, MA | $82.24 | $65.44 – $93.82 | 1,808 | 3 |
| Durham, NH | $47.90 | $28.95 – $86.26 | 1,807 | 5 |
| Colorado Spgs, CO | $25.75 | $25.36 – $52.32 | 1,807 | 2 |
| Niwot, CO | $54.72 | $46.25 – $80.94 | 1,806 | 2 |
| Scotia, NY | $83.70 | $59.61 – $98.05 | 1,805 | 3 |
| Ashland, KS | $105.34 | $29.24 – $227.16 | 1,805 | 2 |
| Warrendale, PA | $31.13 | $15.96 – $34.80 | 1,805 | 3 |
| Kouts, IN | $41.14 | $41.14 – $41.14 | 1,805 | 1 |
| Voorheesville, NY | $93.09 | $93.09 – $93.09 | 1,803 | 1 |
| Motnezuma Creek, UT | $356.78 | $356.78 – $356.78 | 1,803 | 1 |
| Richmond, MN | $162.21 | $161.33 – $162.25 | 1,802 | 2 |
| Livingston, KY | $32.28 | $32.28 – $32.28 | 1,800 | 1 |
| Tafton, PA | $0.70 | $0.00 – $1.94 | 1,800 | 4 |
| Forest, OH | $32.98 | $21.29 – $33.07 | 1,799 | 2 |
| Farmington, IA | $0.00 | $0.00 – $0.00 | 1,799 | 1 |
| Mishicot, WI | $31.35 | $26.72 – $31.85 | 1,795 | 2 |
| White Lake, NY | $144.55 | $144.55 – $144.55 | 1,795 | 1 |
| Elka Park, NY | $62.92 | $62.92 – $62.92 | 1,793 | 1 |
| Coventry Township, OH | $38.70 | $30.74 – $39.31 | 1,790 | 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.