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 |
|---|---|---|---|---|
| Atlantis, FL | $50.70 | $0.41 – $156.43 | 80,849 | 50 |
| Weston, WV | $33.24 | $0.00 – $91.67 | 80,634 | 38 |
| Columbiana, OH | $35.92 | $11.20 – $79.11 | 80,589 | 36 |
| O Fallon, MO | $64.45 | $0.00 – $213.85 | 80,507 | 105 |
| Sanford, ME | $37.53 | $19.92 – $100.65 | 80,495 | 62 |
| Danielson, CT | $29.90 | $0.00 – $58.68 | 80,477 | 23 |
| Greencastle, IN | $54.35 | $0.00 – $78.22 | 80,385 | 36 |
| Fremont, NE | $55.48 | $3.90 – $226.94 | 80,364 | 68 |
| Twinsburg, OH | $53.11 | $12.47 – $305.33 | 80,359 | 61 |
| Moncks Corner, SC | $82.98 | $4.09 – $249.24 | 80,343 | 46 |
| Columbus, NE | $73.80 | $7.53 – $331.23 | 80,330 | 66 |
| Welch, WV | $28.52 | $0.00 – $73.14 | 80,199 | 15 |
| East Palo Alto, CA | $23.64 | $0.75 – $1,219 | 80,179 | 23 |
| Mc Lean, VA | $53.15 | $0.29 – $192.60 | 80,082 | 97 |
| Warren, PA | $38.45 | $0.00 – $122.87 | 80,069 | 58 |
| Green Valley, AZ | $15.77 | $0.00 – $447.96 | 80,018 | 41 |
| Patillas, PR | $1.54 | $0.00 – $42.36 | 80,016 | 18 |
| Langhorne, PA | $49.28 | $0.00 – $147.79 | 79,995 | 113 |
| Dry Ridge, KY | $39.89 | $15.14 – $46.34 | 79,932 | 7 |
| Live Oak, CA | $8.58 | $1.13 – $27.20 | 79,810 | 4 |
| Lock Haven, PA | $42.44 | $0.00 – $83.90 | 79,766 | 30 |
| Clinton, IN | $56.61 | $40.56 – $75.77 | 79,750 | 25 |
| Morgantown, KY | $29.77 | $10.76 – $57.90 | 79,744 | 18 |
| Howell, NJ | $54.79 | $2.56 – $107.04 | 79,733 | 38 |
| Norristown, PA | $51.02 | $0.00 – $624.79 | 79,673 | 51 |
| Idabel, OK | $163.66 | $0.00 – $685.76 | 79,670 | 40 |
| Verona, NJ | $57.79 | $0.00 – $131.83 | 79,633 | 47 |
| Lewistown, PA | $41.68 | $0.00 – $117.48 | 79,452 | 65 |
| Louisville, MS | $65.70 | $24.06 – $160.11 | 79,432 | 34 |
| Homer, AK | $135.12 | $0.87 – $608.46 | 79,250 | 50 |
| La Plata, MD | $99.49 | $5.44 – $159.54 | 79,231 | 44 |
| Erwin, TN | $39.80 | $12.49 – $65.89 | 79,081 | 21 |
| Anacortes, WA | $48.84 | $3.49 – $92.14 | 79,021 | 64 |
| Mcdonough, GA | $61.60 | $0.00 – $123.78 | 79,008 | 36 |
| Darien, IL | $48.61 | $23.69 – $90.92 | 78,965 | 15 |
| Wappingers Falls, NY | $78.00 | $36.85 – $203.06 | 78,932 | 47 |
| Oneonta, AL | $22.83 | $0.00 – $224.31 | 78,907 | 24 |
| Plainfield, IL | $54.66 | $2.88 – $285.18 | 78,885 | 51 |
| Maquoketa, IA | $40.95 | $25.24 – $96.15 | 78,854 | 17 |
| Batesville, IN | $53.90 | $0.00 – $84.11 | 78,802 | 59 |
| Old Town, ME | $7.74 | $3.18 – $92.80 | 78,791 | 9 |
| Berwyn Heights, MD | $69.73 | $3.92 – $158.66 | 78,653 | 22 |
| Broomfield, CO | $63.20 | $0.00 – $120.89 | 78,634 | 66 |
| Mchenry, IL | $36.87 | $0.05 – $114.65 | 78,575 | 86 |
| Cheraw, SC | $65.61 | $16.60 – $338.07 | 78,507 | 24 |
| South Point, OH | $37.71 | $1.72 – $115.48 | 78,478 | 16 |
| Colville, WA | $41.02 | $0.77 – $93.52 | 78,466 | 42 |
| Beaumont, CA | $25.07 | $0.00 – $426.02 | 78,441 | 26 |
| Platteville, WI | $45.23 | $6.82 – $83.68 | 78,435 | 60 |
| Metropolis, IL | $9.04 | $0.00 – $88.30 | 78,403 | 16 |
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.