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 |
|---|---|---|---|---|
| Concord, MA | $63.07 | $0.00 – $372.71 | 76,465 | 78 |
| Ruleville, MS | $109.54 | $8.49 – $217.09 | 76,389 | 24 |
| Lawrence, NY | $67.39 | $2.19 – $127.48 | 76,360 | 25 |
| Vienna, WV | $70.09 | $9.59 – $105.99 | 76,348 | 46 |
| Tawas City, MI | $99.72 | $5.08 – $172.25 | 76,310 | 12 |
| Socorro, NM | $88.56 | $7.59 – $167.41 | 76,169 | 25 |
| Milan, TN | $34.62 | $0.00 – $54.37 | 76,166 | 21 |
| Manhattan, KS | $32.27 | $0.00 – $155.53 | 76,160 | 92 |
| Champlain, NY | $57.86 | $43.93 – $97.51 | 76,154 | 19 |
| Darby, PA | $55.31 | $0.00 – $95.96 | 76,138 | 59 |
| Ottawa, KS | $77.59 | $0.00 – $205.03 | 76,113 | 29 |
| Orange, VA | $55.84 | $15.66 – $74.92 | 76,101 | 31 |
| Dixon, IL | $42.04 | $13.55 – $94.98 | 76,053 | 59 |
| Nyack, NY | $75.13 | $1.30 – $168.71 | 76,039 | 54 |
| West Frankfort, IL | $0.45 | $0.00 – $46.11 | 75,958 | 6 |
| Mocksville, NC | $53.85 | $0.00 – $175.28 | 75,938 | 37 |
| Eastchester, NY | $56.31 | $9.45 – $166.95 | 75,888 | 36 |
| Cedar Bluff, VA | $43.88 | $26.17 – $73.57 | 75,888 | 15 |
| Iron Mountain, MI | $46.11 | $2.52 – $101.94 | 75,865 | 39 |
| Laguna Woods, CA | $37.03 | $0.36 – $77.93 | 75,853 | 22 |
| Arleta, CA | $5.46 | $0.00 – $40.73 | 75,661 | 17 |
| Sacaton, AZ | $71.01 | $0.00 – $99.20 | 75,651 | 56 |
| Prince George, VA | $59.87 | $15.97 – $86.24 | 75,613 | 29 |
| Waterford, CA | $19.66 | $0.31 – $27.87 | 75,567 | 6 |
| Gloucester, VA | $58.33 | $11.78 – $173.46 | 75,548 | 58 |
| Carthage, MO | $62.12 | $14.86 – $182.70 | 75,530 | 36 |
| Cherokee, NC | $411.87 | $48.21 – $654.00 | 75,473 | 52 |
| Denton, MD | $114.25 | $0.00 – $202.39 | 75,392 | 28 |
| Pennington, NJ | $67.53 | $4.25 – $156.61 | 75,303 | 96 |
| Salem, IN | $53.65 | $12.94 – $74.77 | 75,186 | 22 |
| Miles City, MT | $36.19 | $0.00 – $2,042 | 75,088 | 27 |
| Cedar Knolls, NJ | $59.05 | $0.00 – $107.10 | 75,005 | 54 |
| Agoura Hills, CA | $39.99 | $1.01 – $144.90 | 74,970 | 14 |
| Monroe, WI | $36.04 | $7.24 – $131.04 | 74,968 | 83 |
| Richland Center, WI | $37.39 | $0.00 – $58.30 | 74,952 | 35 |
| Storm Lake, IA | $11.29 | $0.00 – $455.00 | 74,935 | 33 |
| Tehachapi, CA | $32.78 | $0.00 – $400.84 | 74,872 | 27 |
| Grants, NM | $140.28 | $33.19 – $156.19 | 74,843 | 15 |
| Calabasas, CA | $21.28 | $0.00 – $303.84 | 74,766 | 38 |
| Grand Rapids, MN | $64.24 | $3.24 – $130.41 | 74,765 | 79 |
| Fuquay Varina, NC | $50.13 | $0.00 – $138.24 | 74,755 | 57 |
| Wynne, AR | $28.99 | $0.30 – $51.82 | 74,741 | 27 |
| Flora, IL | $6.89 | $0.00 – $118.53 | 74,720 | 8 |
| East Alton, IL | $0.65 | $0.00 – $45.96 | 74,692 | 2 |
| Deer Park, WA | $47.32 | $7.31 – $91.29 | 74,653 | 26 |
| Ephrata, PA | $39.20 | $0.00 – $180.97 | 74,582 | 87 |
| Rockwall, TX | $44.51 | $0.00 – $92.20 | 74,563 | 48 |
| Austin, IN | $46.46 | $35.34 – $75.67 | 74,526 | 10 |
| Johnston, IA | $37.35 | $0.00 – $91.84 | 74,524 | 36 |
| Tewksbury, MA | $56.32 | $7.90 – $88.72 | 74,411 | 32 |
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.