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 |
|---|---|---|---|---|
| Middlebury, VT | $40.08 | $1.19 – $105.60 | 70,234 | 58 |
| Coffeyville, KS | $102.87 | $0.00 – $205.51 | 70,218 | 33 |
| Kotzebue, AK | $146.68 | $0.00 – $581.85 | 70,120 | 58 |
| Hughson, CA | $8.38 | $0.02 – $26.59 | 70,111 | 7 |
| Prosper, TX | $51.73 | $0.00 – $481.22 | 70,106 | 49 |
| Carrollton, OH | $50.06 | $1.45 – $80.85 | 70,100 | 18 |
| East St Louis, IL | $0.11 | $0.01 – $139.34 | 70,038 | 3 |
| Islandia, NY | $87.06 | $14.49 – $175.13 | 70,021 | 43 |
| Catskill, NY | $75.41 | $10.81 – $120.18 | 69,990 | 23 |
| Southlake, TX | $51.00 | $0.00 – $106.88 | 69,951 | 42 |
| Fernandina Beach, FL | $49.26 | $0.00 – $134.97 | 69,898 | 35 |
| Le Mars, IA | $47.93 | $0.00 – $64.38 | 69,886 | 30 |
| Portland, IN | $61.07 | $29.98 – $147.01 | 69,855 | 32 |
| Ft Lauderdale, FL | $41.46 | $0.00 – $654.00 | 69,835 | 68 |
| Fallon, NV | $23.93 | $0.00 – $191.23 | 69,817 | 31 |
| South Lake Tahoe, CA | $25.02 | $0.15 – $1,075 | 69,717 | 43 |
| Stuart, VA | $60.79 | $15.84 – $67.18 | 69,707 | 10 |
| Port Jervis, NY | $72.50 | $26.40 – $151.41 | 69,693 | 26 |
| Washington, IL | $51.06 | $24.50 – $105.06 | 69,660 | 26 |
| Ruidoso, NM | $74.10 | $11.91 – $122.48 | 69,659 | 24 |
| Waverly, IA | $35.42 | $0.00 – $73.85 | 69,653 | 43 |
| Berlin, NJ | $64.87 | $1.48 – $119.27 | 69,611 | 25 |
| Hacienda Heights, CA | $16.54 | $0.00 – $73.14 | 69,563 | 47 |
| Reedsburg, WI | $45.33 | $7.72 – $85.31 | 69,512 | 40 |
| State College, PA | $49.40 | $0.00 – $203.56 | 69,509 | 124 |
| Nutley, NJ | $49.06 | $0.29 – $88.08 | 69,464 | 34 |
| Fort Carson, CO | $95.88 | $1.46 – $852.59 | 69,449 | 43 |
| Naguabo, PR | $11.87 | $0.00 – $58.70 | 69,437 | 20 |
| Lake City, SC | $66.22 | $5.38 – $143.58 | 69,428 | 34 |
| Geneseo, NY | $90.38 | $4.18 – $138.22 | 69,387 | 27 |
| Dublin, VA | $59.38 | $3.63 – $73.75 | 69,309 | 23 |
| Seminole, OK | $88.59 | $0.00 – $201.80 | 69,306 | 21 |
| Youngsville, LA | $38.79 | $3.93 – $104.85 | 69,299 | 25 |
| Fort Kent, ME | $15.13 | $0.29 – $84.68 | 69,238 | 17 |
| San Marcos, TX | $46.10 | $0.00 – $250.87 | 69,208 | 62 |
| Avon Park, FL | $15.08 | $0.00 – $99.20 | 69,180 | 30 |
| Neosho, MO | $98.00 | $10.79 – $196.83 | 69,173 | 40 |
| East Saint Louis, IL | $5.98 | $0.00 – $60.08 | 69,103 | 18 |
| Pleasant Hill, IA | $38.30 | $5.93 – $40.55 | 69,078 | 21 |
| St. Francisville, LA | $43.01 | $20.76 – $66.93 | 69,075 | 9 |
| Garfield Hts, OH | $37.50 | $8.63 – $110.50 | 69,069 | 40 |
| Ladson, SC | $58.12 | $14.20 – $142.04 | 69,061 | 36 |
| Moulton, AL | $27.19 | $0.00 – $231.97 | 69,044 | 16 |
| Three Rivers, MI | $19.60 | $4.93 – $72.74 | 69,037 | 16 |
| Hinton, WV | $21.89 | $0.00 – $70.02 | 68,963 | 18 |
| Coram, NY | $72.24 | $4.47 – $127.97 | 68,852 | 22 |
| Payson, AZ | $45.14 | $0.22 – $262.87 | 68,826 | 49 |
| Elkhorn, NE | $58.54 | $11.16 – $170.44 | 68,797 | 61 |
| Battle Ground, WA | $41.07 | $3.79 – $229.96 | 68,791 | 41 |
| Burbank, IL | $55.54 | $16.85 – $96.12 | 68,688 | 27 |
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.