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 |
|---|---|---|---|---|
| Rock Falls, IL | $13.28 | $0.02 – $74.86 | 74,327 | 8 |
| Dumfries, VA | $62.26 | $15.55 – $117.91 | 74,268 | 29 |
| Haverstraw, NY | $81.51 | $13.54 – $116.49 | 74,252 | 10 |
| Coalinga, CA | $3.96 | $0.00 – $655.40 | 74,240 | 8 |
| Pleasant Prairie, WI | $36.75 | $14.48 – $110.66 | 74,233 | 59 |
| Opp, AL | $60.65 | $0.94 – $85.64 | 74,204 | 23 |
| Rocky Mount, VA | $55.55 | $0.00 – $79.17 | 74,196 | 46 |
| Andover, MA | $50.04 | $2.03 – $165.49 | 74,099 | 68 |
| Olla, LA | $4.99 | $0.00 – $34.52 | 74,088 | 9 |
| Harrison, NY | $108.58 | $0.00 – $154.49 | 74,057 | 41 |
| Pompton Plains, NJ | $52.33 | $3.25 – $120.42 | 74,026 | 29 |
| Des Moines, WA | $39.91 | $0.58 – $110.97 | 73,993 | 54 |
| Dowagiac, MI | $34.56 | $1.53 – $527.32 | 73,984 | 14 |
| Poulsbo, WA | $46.99 | $4.37 – $238.05 | 73,973 | 70 |
| Springfield, PA | $37.56 | $0.00 – $83.59 | 73,960 | 87 |
| Haines City, FL | $75.22 | $0.00 – $150.43 | 73,959 | 23 |
| Camden, DE | $62.86 | $0.00 – $84.91 | 73,867 | 13 |
| Shrewsbury, NJ | $57.87 | $1.13 – $123.49 | 73,813 | 32 |
| Alpine, CA | $15.81 | $0.00 – $115.14 | 73,745 | 29 |
| Tooele, UT | $111.82 | $5.47 – $717.11 | 73,744 | 50 |
| Moberly, MO | $67.47 | $3.49 – $128.94 | 73,705 | 50 |
| Immokalee, FL | $35.54 | $15.45 – $60.27 | 73,492 | 27 |
| Scott, LA | $40.63 | $0.98 – $70.84 | 73,468 | 11 |
| Bryant, AR | $39.28 | $8.84 – $70.03 | 73,442 | 30 |
| Bonney Lake, WA | $63.70 | $3.12 – $108.29 | 73,329 | 49 |
| Southborough, MA | $70.32 | $1.25 – $133.67 | 73,250 | 43 |
| Elberton, GA | $62.29 | $58.10 – $69.55 | 73,233 | 7 |
| Berkley, MI | $57.30 | $38.56 – $296.66 | 73,203 | 15 |
| Delta, CO | $106.97 | $0.00 – $556.32 | 73,147 | 55 |
| Brown Deer, WI | $35.80 | $14.60 – $64.84 | 73,144 | 32 |
| Kalkaska, MI | $13.42 | $0.59 – $75.73 | 73,099 | 4 |
| Sunland, CA | $1.22 | $0.11 – $26.14 | 73,056 | 8 |
| Mexico, MO | $76.24 | $0.00 – $152.85 | 73,055 | 43 |
| Hamilton, MT | $17.44 | $0.00 – $192.34 | 73,013 | 31 |
| Kaufman, TX | $40.98 | $0.00 – $73.56 | 72,990 | 15 |
| Millersville, MD | $102.79 | $0.00 – $170.96 | 72,966 | 34 |
| Green Brook, NJ | $66.35 | $1.54 – $121.80 | 72,959 | 23 |
| Maxwelton, WV | $47.53 | $0.00 – $57.68 | 72,865 | 7 |
| Ontario, OR | $26.23 | $0.00 – $97.48 | 72,862 | 64 |
| Del Rio, TX | $36.71 | $0.00 – $405.37 | 72,778 | 35 |
| Altus, OK | $124.28 | $8.53 – $229.21 | 72,770 | 51 |
| Crofton, MD | $86.80 | $0.00 – $187.59 | 72,709 | 33 |
| Clemson, SC | $62.21 | $18.10 – $135.41 | 72,659 | 47 |
| Kentwood, MI | $71.54 | $26.75 – $75.50 | 72,643 | 6 |
| Daphne, AL | $65.81 | $0.00 – $747.82 | 72,629 | 43 |
| Payette, ID | $43.66 | $1.32 – $79.70 | 72,602 | 15 |
| Palisades Park, NJ | $47.77 | $0.00 – $191.35 | 72,549 | 11 |
| Yadkinville, NC | $64.67 | $26.90 – $81.82 | 72,533 | 27 |
| New Richmond, WI | $54.43 | $5.33 – $64.36 | 72,420 | 35 |
| Marshall, MN | $105.71 | $6.09 – $260.88 | 72,402 | 62 |
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.