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 |
|---|---|---|---|---|
| Portage, WI | $37.21 | $9.45 – $80.98 | 67,254 | 58 |
| Carlisle, PA | $31.90 | $0.00 – $102.01 | 67,249 | 62 |
| Port Allen, LA | $26.00 | $0.00 – $60.91 | 67,220 | 23 |
| Cumming, GA | $53.66 | $0.00 – $248.18 | 67,186 | 55 |
| Florida City, FL | $24.78 | $3.26 – $65.88 | 67,074 | 7 |
| Derby, NY | $61.79 | $15.67 – $104.08 | 67,021 | 21 |
| Keokuk, IA | $10.55 | $0.00 – $62.07 | 67,006 | 22 |
| Ellisville, MS | $73.56 | $5.48 – $129.74 | 67,000 | 25 |
| Martins Ferry, OH | $61.13 | $6.85 – $102.08 | 66,992 | 22 |
| Mer Rouge, LA | $26.31 | $0.00 – $39.46 | 66,969 | 5 |
| Watseka, IL | $22.40 | $0.01 – $116.32 | 66,779 | 25 |
| Tell City, IN | $50.61 | $5.63 – $88.41 | 66,770 | 29 |
| Arroyo, PR | $7.37 | $0.00 – $56.70 | 66,733 | 15 |
| N Charleston, SC | $55.48 | $0.00 – $128.14 | 66,720 | 49 |
| Merritt Island, FL | $46.83 | $0.00 – $125.29 | 66,625 | 53 |
| Man, WV | $10.74 | $0.00 – $30.04 | 66,616 | 8 |
| Greenfield, CA | $21.70 | $1.27 – $157.42 | 66,532 | 7 |
| North Little Rock, AR | $34.49 | $0.00 – $132.80 | 66,531 | 109 |
| Mc Kee, KY | $35.00 | $0.19 – $54.38 | 66,463 | 12 |
| Fostoria, OH | $38.36 | $18.27 – $96.74 | 66,440 | 21 |
| Colonia, NJ | $50.70 | $0.00 – $83.85 | 66,420 | 12 |
| Parma Heights, OH | $50.04 | $10.74 – $117.23 | 66,411 | 8 |
| Fort Lupton, CO | $118.05 | $36.50 – $192.93 | 66,381 | 18 |
| Plymouth, MI | $58.64 | $16.82 – $69.63 | 66,325 | 14 |
| Hayward, WI | $62.26 | $14.91 – $131.76 | 66,288 | 50 |
| Sebastian, FL | $34.87 | $0.00 – $85.30 | 66,282 | 47 |
| Duffield, VA | $58.24 | $15.71 – $81.65 | 66,249 | 9 |
| Oskaloosa, IA | $35.74 | $0.85 – $222.50 | 66,231 | 52 |
| Bar Harbor, ME | $11.35 | $0.00 – $86.02 | 66,185 | 31 |
| Dayville, CT | $47.83 | $0.00 – $64.76 | 66,143 | 16 |
| Lake Geneva, WI | $30.31 | $7.43 – $89.98 | 66,082 | 61 |
| Charlotte, MI | $56.45 | $7.10 – $76.43 | 66,040 | 15 |
| Little Silver, NJ | $66.35 | $10.95 – $123.29 | 66,031 | 22 |
| Lake Isabella, CA | $31.34 | $0.00 – $627.26 | 66,007 | 10 |
| Walpole, MA | $64.46 | $0.00 – $110.27 | 65,949 | 31 |
| Kennebunk, ME | $40.53 | $4.99 – $68.66 | 65,867 | 58 |
| Chapmanville, WV | $33.99 | $0.00 – $69.04 | 65,785 | 19 |
| Olive Hill, KY | $31.31 | $0.00 – $47.17 | 65,760 | 16 |
| Columbia City, IN | $60.74 | $35.85 – $99.00 | 65,739 | 33 |
| Auxier, KY | $29.53 | $7.39 – $43.20 | 65,730 | 9 |
| Ashdown, AR | $33.40 | $16.30 – $44.14 | 65,709 | 15 |
| Gillespie, IL | $7.00 | $0.00 – $72.09 | 65,667 | 9 |
| Demopolis, AL | $31.87 | $0.00 – $219.89 | 65,537 | 22 |
| Ponchatoula, LA | $34.06 | $0.00 – $50.98 | 65,502 | 21 |
| Raymore, MO | $32.54 | $0.55 – $138.56 | 65,488 | 25 |
| Springville, NY | $49.97 | $0.00 – $132.39 | 65,467 | 36 |
| Dickinson, ND | $79.36 | $22.99 – $380.48 | 65,446 | 62 |
| Pierre, SD | $64.60 | $0.00 – $469.32 | 65,440 | 15 |
| Bellevue, NE | $62.37 | $5.08 – $161.54 | 65,416 | 62 |
| San Carlos, CA | $43.41 | $0.00 – $1,247 | 65,405 | 48 |
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.