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 |
|---|---|---|---|---|
| Willcox, AZ | $49.19 | $0.00 – $97.00 | 59,054 | 12 |
| Sturgeon Bay, WI | $24.27 | $2.64 – $72.90 | 59,038 | 45 |
| Jefferson, NC | $50.14 | $0.00 – $72.80 | 59,028 | 41 |
| Texas City, TX | $61.76 | $0.00 – $645.44 | 59,003 | 30 |
| Brewster, NY | $98.67 | $0.00 – $260.57 | 59,002 | 57 |
| Sheridan, AR | $38.66 | $1.17 – $62.32 | 58,997 | 21 |
| Siloam Springs, AR | $39.74 | $0.89 – $53.46 | 58,905 | 29 |
| Greendale, IN | $49.14 | $27.56 – $63.47 | 58,884 | 17 |
| Elko, NV | $52.20 | $0.00 – $91.66 | 58,882 | 44 |
| Cocoa, FL | $61.59 | $0.00 – $71.35 | 58,829 | 21 |
| Ooltewah, TN | $36.14 | $3.87 – $86.83 | 58,788 | 48 |
| Harper Woods, MI | $59.45 | $44.98 – $67.37 | 58,766 | 6 |
| Mount Carmel, IL | $5.97 | $0.01 – $71.65 | 58,709 | 16 |
| Independence, KS | $83.87 | $0.00 – $200.61 | 58,696 | 22 |
| Benson, AZ | $27.49 | $0.45 – $103.35 | 58,686 | 17 |
| Swansea, IL | $48.42 | $0.00 – $99.20 | 58,643 | 30 |
| Goshen, NY | $100.35 | $7.05 – $142.82 | 58,628 | 50 |
| Mangham, LA | $3.41 | $0.00 – $14.82 | 58,617 | 8 |
| Jenkins, KY | $35.87 | $25.70 – $37.37 | 58,525 | 5 |
| Woodward, OK | $130.03 | $0.00 – $275.33 | 58,494 | 26 |
| Landover Hills, MD | $52.67 | $0.00 – $140.53 | 58,417 | 11 |
| Selinsgrove, PA | $41.20 | $18.13 – $67.21 | 58,409 | 19 |
| Little Falls, MN | $44.77 | $11.29 – $209.28 | 58,388 | 42 |
| Devils Lake, ND | $127.50 | $35.19 – $958.75 | 58,366 | 34 |
| Prineville, OR | $31.36 | $0.00 – $320.24 | 58,342 | 33 |
| Cassopolis, MI | $17.23 | $1.94 – $168.26 | 58,336 | 5 |
| Chubbuck, ID | $51.73 | $0.00 – $105.25 | 58,318 | 34 |
| Church Point, LA | $34.83 | $3.03 – $65.10 | 58,303 | 11 |
| Alexandria, MN | $67.85 | $25.46 – $324.17 | 58,238 | 84 |
| Brevard, NC | $53.89 | $1.56 – $83.70 | 58,221 | 38 |
| Brookville, IN | $53.46 | $16.59 – $77.76 | 58,186 | 22 |
| Gladwin, MI | $26.69 | $21.61 – $74.31 | 58,167 | 6 |
| Summit, IL | $31.37 | $0.01 – $86.18 | 58,155 | 6 |
| Pryor, OK | $125.76 | $7.72 – $202.19 | 58,149 | 28 |
| Proctorville, OH | $38.91 | $1.07 – $72.64 | 58,128 | 15 |
| Tucker, GA | $36.09 | $3.25 – $168.00 | 58,121 | 32 |
| Stayton, OR | $37.73 | $6.03 – $98.76 | 58,101 | 35 |
| Newhall, CA | $19.54 | $0.00 – $111.88 | 58,087 | 21 |
| Syosset, NY | $81.46 | $6.99 – $225.77 | 57,994 | 51 |
| Pennsauken, NJ | $34.38 | $6.06 – $79.24 | 57,929 | 24 |
| Roslyn, NY | $92.98 | $0.00 – $205.75 | 57,913 | 48 |
| Homewood, IL | $57.71 | $11.61 – $318.75 | 57,877 | 27 |
| Essex, CT | $53.12 | $0.00 – $174.57 | 57,852 | 30 |
| Pine Ridge, SD | $366.25 | $0.00 – $370.14 | 57,804 | 5 |
| Lamar, CO | $143.22 | $31.89 – $312.58 | 57,787 | 29 |
| Hampstead, NC | $58.08 | $15.48 – $92.44 | 57,755 | 29 |
| Schertz, TX | $47.36 | $8.05 – $104.04 | 57,737 | 44 |
| Livermore, CA | $6.20 | $0.00 – $133.44 | 57,687 | 36 |
| Bedford, OH | $50.76 | $6.41 – $124.74 | 57,676 | 24 |
| Waller, TX | $33.47 | $7.60 – $42.50 | 57,670 | 7 |
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.