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 |
|---|---|---|---|---|
| Stanton, MI | $214.40 | $11.87 – $336.30 | 45,761 | 9 |
| Butler, KY | $35.64 | $27.97 – $42.03 | 45,747 | 7 |
| Madisonville, LA | $36.66 | $1.71 – $78.88 | 45,740 | 17 |
| Adelphi, MD | $90.28 | $32.50 – $293.30 | 45,726 | 9 |
| Barre, MA | $40.77 | $4.28 – $107.58 | 45,673 | 22 |
| New Canton, VA | $43.47 | $12.34 – $68.37 | 45,625 | 14 |
| Middleboro, MA | $55.35 | $25.95 – $90.90 | 45,617 | 23 |
| Sandwich, MA | $62.23 | $4.01 – $85.00 | 45,568 | 20 |
| Brainerd, MN | $90.92 | $11.62 – $597.00 | 45,550 | 81 |
| Gun Barrel City, TX | $31.65 | $4.62 – $55.17 | 45,534 | 17 |
| Laguna Beach, CA | $30.85 | $0.00 – $122.76 | 45,516 | 18 |
| Montoursville, PA | $39.05 | $0.00 – $108.77 | 45,489 | 20 |
| Clewiston, FL | $47.72 | $6.55 – $63.90 | 45,471 | 16 |
| Bisbee, AZ | $5.51 | $0.00 – $78.82 | 45,401 | 19 |
| Pleasanton, TX | $36.19 | $0.00 – $55.64 | 45,343 | 16 |
| Shawano, WI | $42.96 | $8.02 – $165.34 | 45,315 | 46 |
| Lehighton, PA | $34.42 | $0.17 – $98.87 | 45,274 | 38 |
| Stone Mountain, GA | $72.14 | $2.06 – $123.38 | 45,244 | 26 |
| Randolph, VT | $14.97 | $0.00 – $82.21 | 45,213 | 38 |
| Santa Rosa Beach, FL | $40.06 | $1.36 – $137.75 | 45,191 | 29 |
| Boonville, IN | $53.36 | $14.34 – $93.68 | 45,178 | 23 |
| White City, OR | $66.99 | $52.28 – $94.07 | 45,152 | 16 |
| Canyon Country, CA | $14.17 | $0.00 – $133.24 | 45,129 | 21 |
| North Myrtle Beach, SC | $69.48 | $10.59 – $104.88 | 45,124 | 24 |
| Grove Hill, AL | $33.20 | $0.00 – $212.93 | 45,080 | 9 |
| Bala Cynwyd, PA | $38.70 | $0.00 – $69.55 | 45,046 | 46 |
| Cabot, AR | $33.06 | $0.00 – $282.17 | 44,975 | 55 |
| Hampton Bays, NY | $75.42 | $46.73 – $223.68 | 44,969 | 16 |
| Delphi, IN | $56.03 | $14.20 – $70.16 | 44,956 | 15 |
| Rosedale, NY | $57.25 | $0.00 – $169.83 | 44,949 | 21 |
| Black River Falls, WI | $50.25 | $0.00 – $156.95 | 44,896 | 45 |
| Monmouth, IL | $2.32 | $0.16 – $42.59 | 44,882 | 7 |
| Clyde, OH | $51.96 | $17.20 – $77.56 | 44,881 | 20 |
| Bucksport, ME | $4.51 | $0.00 – $63.22 | 44,871 | 6 |
| Lynbrook, NY | $71.74 | $0.00 – $187.59 | 44,819 | 48 |
| Damascus, MD | $84.69 | $15.42 – $220.07 | 44,810 | 30 |
| Great Barrington, MA | $80.33 | $12.95 – $297.53 | 44,810 | 25 |
| Kilmarnock, VA | $53.01 | $0.00 – $208.89 | 44,799 | 21 |
| Riverdale, CA | $1.71 | $0.00 – $4.65 | 44,768 | 9 |
| Fort Campbell, KY | $44.98 | $14.66 – $117.88 | 44,759 | 51 |
| Londonderry, NH | $49.99 | $0.00 – $266.22 | 44,706 | 49 |
| Thomaston, GA | $76.74 | $0.00 – $106.01 | 44,702 | 7 |
| Anamosa, IA | $3.56 | $0.00 – $49.10 | 44,657 | 12 |
| Mendenhall, MS | $56.80 | $7.03 – $129.52 | 44,589 | 16 |
| Agawam, MA | $49.00 | $6.91 – $136.41 | 44,567 | 21 |
| Quincy, FL | $50.23 | $3.99 – $94.93 | 44,506 | 20 |
| Atchison, KS | $145.24 | $3.40 – $181.65 | 44,503 | 23 |
| Sneedville, TN | $35.25 | $26.07 – $45.40 | 44,492 | 13 |
| Seal Beach, CA | $10.27 | $0.00 – $73.48 | 44,492 | 20 |
| Madison Heights, VA | $57.88 | $30.98 – $117.62 | 44,464 | 16 |
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.