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 |
|---|---|---|---|---|
| Hidalgo, TX | $27.47 | $27.47 – $27.47 | 1,195 | 1 |
| Hazel Green, KY | $40.22 | $40.22 – $40.22 | 1,193 | 1 |
| Prescott, WI | $42.91 | $11.07 – $53.03 | 1,191 | 3 |
| Rison, AR | $31.79 | $3.70 – $70.72 | 1,190 | 4 |
| Jasper, AR | $14.17 | $9.22 – $23.68 | 1,189 | 3 |
| Welch, OK | $1.79 | $1.79 – $1.79 | 1,187 | 1 |
| Valley Spgs, CA | $15.73 | $15.73 – $15.73 | 1,185 | 1 |
| Cape Giradeau, MO | $36.95 | $36.95 – $36.95 | 1,183 | 1 |
| Dekalb, NY | $65.57 | $65.57 – $65.57 | 1,183 | 1 |
| Temescal Valley, CA | $66.66 | $66.63 – $67.32 | 1,182 | 2 |
| Alva, FL | $32.95 | $32.95 – $32.95 | 1,182 | 1 |
| Kalona, IA | $27.81 | $0.18 – $40.13 | 1,182 | 4 |
| The Plains, OH | $127.10 | $127.10 – $127.10 | 1,182 | 1 |
| Cambria Hts, NY | $56.90 | $54.79 – $57.95 | 1,182 | 2 |
| Lincoln, MO | $52.89 | $18.77 – $70.86 | 1,180 | 4 |
| Franklin, NE | $85.65 | $84.75 – $92.67 | 1,179 | 4 |
| Alford, FL | $17.41 | $9.34 – $131.29 | 1,178 | 2 |
| Starbuck, MN | $116.02 | $116.02 – $116.02 | 1,178 | 1 |
| Baltmore, MD | $122.07 | $122.07 – $122.07 | 1,177 | 1 |
| Wrightstown, WI | $31.18 | $31.18 – $31.18 | 1,174 | 1 |
| Centrailia, WA | $96.10 | $96.10 – $96.10 | 1,173 | 1 |
| Soap Lake, WA | $60.64 | $60.64 – $60.64 | 1,172 | 1 |
| Scotland Neck, NC | $25.29 | $0.00 – $29.12 | 1,172 | 3 |
| Whitney Point, NY | $94.72 | $63.35 – $112.50 | 1,172 | 2 |
| Fort Ashby, WV | $0.75 | $0.67 – $1.86 | 1,171 | 2 |
| Kake, AK | $15.77 | $15.77 – $15.77 | 1,170 | 1 |
| St. Michaels, MD | $154.48 | $154.48 – $154.48 | 1,170 | 1 |
| Worden, MT | $0.00 | $0.00 – $0.00 | 1,169 | 1 |
| East Berlin, CT | $52.79 | $50.64 – $84.87 | 1,167 | 3 |
| Winslow, ME | $30.91 | $19.49 – $31.99 | 1,165 | 3 |
| Ramsy, NJ | $54.66 | $54.66 – $54.66 | 1,163 | 1 |
| Middletown, KY | $31.32 | $30.56 – $33.30 | 1,162 | 3 |
| Macks Creek, MO | $74.35 | $74.35 – $74.35 | 1,162 | 1 |
| Clallam Bay, WA | $47.97 | $47.97 – $47.97 | 1,161 | 1 |
| Hattlesburg, MS | $58.43 | $58.43 – $58.43 | 1,159 | 1 |
| Wash, DC | $36.69 | $36.69 – $36.69 | 1,159 | 1 |
| Stanardsville, VA | $16.01 | $16.01 – $16.01 | 1,157 | 1 |
| Emory, TX | $48.46 | $0.00 – $53.44 | 1,156 | 3 |
| Heber-Overgaard, AZ | $60.35 | $60.35 – $60.35 | 1,155 | 1 |
| Loxaharchee, FL | $2.65 | $2.65 – $2.65 | 1,154 | 1 |
| Shelbina, MO | $87.73 | $83.15 – $106.42 | 1,153 | 2 |
| Brevig Mission, AK | $382.00 | $369.03 – $427.41 | 1,152 | 3 |
| Hillard, OH | $47.10 | $47.10 – $47.10 | 1,152 | 1 |
| Carbon Hill, AL | $31.32 | $31.32 – $31.32 | 1,150 | 1 |
| Brookfield, IL | $31.83 | $12.67 – $48.76 | 1,149 | 3 |
| Brandon, WI | $12.83 | $12.83 – $12.83 | 1,149 | 1 |
| Albequerque, NM | $83.65 | $48.95 – $84.46 | 1,147 | 2 |
| Hubbard, IA | $34.54 | $34.54 – $34.54 | 1,145 | 1 |
| Garrison, ND | $97.57 | $33.33 – $175.21 | 1,145 | 6 |
| Port Reading, NJ | $108.68 | $108.68 – $108.68 | 1,144 | 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.