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 |
|---|---|---|---|---|
| Forest, MS | $77.75 | $12.73 – $141.29 | 91,741 | 30 |
| Indianola, IA | $36.80 | $0.07 – $94.31 | 91,670 | 36 |
| Hayti, MO | $60.24 | $16.68 – $110.58 | 91,661 | 15 |
| White Hall, AR | $32.11 | $0.00 – $45.27 | 91,650 | 25 |
| Alton, TX | $33.59 | $22.58 – $53.34 | 91,605 | 7 |
| Shirley, NY | $67.97 | $26.09 – $170.29 | 91,587 | 25 |
| North Chicago, IL | $39.60 | $0.00 – $120.31 | 91,571 | 27 |
| Wetumpka, AL | $26.83 | $0.00 – $490.50 | 91,546 | 26 |
| Litchfield, IL | $0.74 | $0.01 – $56.05 | 91,509 | 10 |
| East Patchogue, NY | $81.12 | $0.00 – $169.19 | 91,499 | 67 |
| Manahawkin, NJ | $43.56 | $1.70 – $119.85 | 91,462 | 78 |
| Rock Island, IL | $45.54 | $0.00 – $147.15 | 91,440 | 56 |
| Collinsville, IL | $41.58 | $0.00 – $91.85 | 91,372 | 16 |
| Ewa Beach, HI | $51.56 | $0.07 – $241.54 | 91,353 | 53 |
| Delhi, LA | $6.99 | $0.00 – $68.11 | 91,330 | 23 |
| Omak, WA | $51.60 | $0.00 – $179.13 | 91,277 | 59 |
| Escanaba, MI | $37.00 | $1.29 – $59.68 | 91,232 | 8 |
| Point Pleasant, WV | $48.78 | $7.17 – $86.82 | 91,206 | 28 |
| Dover Foxcroft, ME | $6.67 | $0.00 – $49.65 | 91,149 | 14 |
| Winfield, IL | $66.27 | $0.00 – $171.14 | 91,111 | 126 |
| Fortuna, CA | $4.41 | $0.00 – $668.32 | 91,046 | 37 |
| Highland Heights, KY | $40.64 | $1.58 – $72.88 | 91,000 | 41 |
| Olive Branch, MS | $50.95 | $3.51 – $105.98 | 90,902 | 52 |
| Worthington, OH | $55.81 | $15.88 – $122.52 | 90,878 | 73 |
| Truckee, CA | $34.04 | $0.31 – $87.87 | 90,861 | 96 |
| Lawrenceville, IL | $3.53 | $0.00 – $239.64 | 90,843 | 13 |
| Inkster, MI | $40.73 | $2.13 – $139.20 | 90,762 | 7 |
| Hudson, OH | $57.03 | $13.96 – $112.73 | 90,740 | 68 |
| Belvidere, IL | $30.99 | $0.00 – $383.04 | 90,732 | 35 |
| Huron, SD | $45.56 | $3.21 – $236.52 | 90,641 | 15 |
| Bethany, OK | $91.65 | $32.11 – $163.14 | 90,632 | 40 |
| Clinton, SC | $86.41 | $9.19 – $263.84 | 90,629 | 48 |
| Rockport, ME | $34.82 | $9.51 – $148.14 | 90,628 | 100 |
| Alameda, CA | $28.15 | $0.00 – $178.85 | 90,475 | 72 |
| Elma, WA | $48.43 | $0.00 – $228.12 | 90,440 | 35 |
| West Chester, PA | $52.44 | $0.00 – $109.48 | 90,357 | 129 |
| Moorpark, CA | $13.09 | $0.00 – $340.86 | 90,357 | 33 |
| Waxahachie, TX | $30.03 | $0.00 – $83.35 | 90,335 | 47 |
| Phillipsburg, NJ | $43.59 | $0.00 – $131.17 | 90,294 | 78 |
| Sullivan, MO | $53.57 | $2.55 – $210.81 | 90,058 | 40 |
| Hermitage, PA | $42.72 | $0.00 – $94.03 | 90,032 | 76 |
| Massapequa, NY | $60.67 | $0.00 – $138.28 | 90,025 | 78 |
| Saint Charles, MO | $59.08 | $0.00 – $254.31 | 90,016 | 102 |
| Post Falls, ID | $47.13 | $-0.78 – $105.48 | 90,012 | 104 |
| Diamond Bar, CA | $37.33 | $0.00 – $119.63 | 89,934 | 45 |
| Rohnert Park, CA | $3.80 | $0.00 – $54.08 | 89,899 | 37 |
| New Tazewell, TN | $35.11 | $12.70 – $60.71 | 89,870 | 24 |
| Lordsburg, NM | $213.01 | $63.37 – $214.06 | 89,855 | 3 |
| Superior, WI | $26.15 | $0.00 – $234.61 | 89,816 | 47 |
| Mansfield, LA | $2.43 | $0.00 – $71.15 | 89,808 | 12 |
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.