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 |
|---|---|---|---|---|
| Williamstown, KY | $37.90 | $10.76 – $95.53 | 44,459 | 8 |
| Harpers Ferry, WV | $23.50 | $0.00 – $76.31 | 44,445 | 25 |
| Rye, NY | $90.60 | $11.44 – $112.69 | 44,328 | 16 |
| Sapulpa, OK | $88.82 | $8.15 – $636.70 | 44,316 | 23 |
| Winsted, CT | $69.94 | $6.50 – $76.10 | 44,314 | 11 |
| Davie, FL | $44.60 | $0.00 – $285.56 | 44,307 | 65 |
| Mountainside, NJ | $104.98 | $22.67 – $270.37 | 44,257 | 20 |
| Seneca Falls, NY | $66.20 | $53.42 – $185.25 | 44,237 | 19 |
| Dandridge, TN | $33.57 | $13.33 – $313.84 | 44,223 | 19 |
| Red Springs, NC | $49.19 | $33.19 – $79.54 | 44,220 | 9 |
| Woodbridge, CT | $35.36 | $0.12 – $85.42 | 44,212 | 17 |
| Clinton, OK | $243.43 | $1.73 – $719.00 | 44,196 | 26 |
| Willow Grove, PA | $51.33 | $0.39 – $113.77 | 44,186 | 62 |
| Marshall, TX | $25.13 | $0.00 – $76.03 | 44,181 | 36 |
| Rockaway, NJ | $50.77 | $6.13 – $120.49 | 44,167 | 33 |
| Dallas, PA | $40.58 | $25.92 – $80.31 | 44,162 | 12 |
| Coalgate, OK | $63.74 | $2.29 – $82.32 | 44,148 | 5 |
| Shenandoah, IA | $9.22 | $0.00 – $63.40 | 44,117 | 30 |
| Castle Pines, CO | $83.31 | $19.35 – $319.04 | 44,089 | 27 |
| Bluefield, WV | $28.30 | $0.00 – $92.00 | 44,065 | 36 |
| Tillamook, OR | $93.25 | $36.24 – $486.17 | 44,063 | 32 |
| Penn Yan, NY | $84.02 | $47.71 – $220.90 | 44,062 | 22 |
| Amelia, OH | $53.42 | $7.10 – $87.48 | 44,049 | 15 |
| Keshena, WI | $33.18 | $9.01 – $44.31 | 44,037 | 15 |
| Bridgewater, MA | $50.00 | $0.00 – $104.61 | 44,001 | 25 |
| Sutton, WV | $15.14 | $0.00 – $229.04 | 43,997 | 14 |
| Monroeville, AL | $29.53 | $0.00 – $216.69 | 43,974 | 19 |
| Valrico, FL | $50.97 | $0.00 – $117.52 | 43,972 | 32 |
| Bloomfield, IN | $33.98 | $21.03 – $60.91 | 43,971 | 6 |
| Chicago Ridge, IL | $57.46 | $6.91 – $256.49 | 43,961 | 35 |
| Roselle, NJ | $37.01 | $0.00 – $45.70 | 43,957 | 11 |
| Deerfield Beach, FL | $32.29 | $0.00 – $262.30 | 43,951 | 54 |
| Sheldon, IA | $7.14 | $0.05 – $55.12 | 43,932 | 13 |
| Port Matilda, PA | $39.54 | $0.58 – $131.21 | 43,919 | 40 |
| Port Royal, SC | $84.85 | $31.21 – $235.10 | 43,918 | 20 |
| Stoughton, MA | $58.82 | $2.48 – $118.32 | 43,913 | 38 |
| Danville, IN | $56.05 | $7.17 – $92.03 | 43,878 | 77 |
| Prairie Du Chien, WI | $84.33 | $16.02 – $181.56 | 43,872 | 29 |
| Northglenn, CO | $63.21 | $0.00 – $116.12 | 43,864 | 38 |
| Montour Falls, NY | $120.00 | $13.10 – $199.48 | 43,861 | 13 |
| Kearney, NJ | $52.63 | $52.63 – $52.63 | 43,857 | 1 |
| Cartersville, GA | $48.76 | $1.47 – $82.34 | 43,838 | 25 |
| Buttonwillow, CA | $23.63 | $20.87 – $24.99 | 43,829 | 2 |
| Davidson, NC | $65.53 | $9.89 – $318.75 | 43,827 | 38 |
| Warrenville, IL | $49.98 | $10.33 – $97.20 | 43,773 | 50 |
| Port Clinton, OH | $37.91 | $6.45 – $52.71 | 43,760 | 18 |
| Trotwood, OH | $53.15 | $39.02 – $64.17 | 43,749 | 7 |
| Georgetown, IL | $0.00 | $0.00 – $0.00 | 43,702 | 1 |
| Madison, OH | $50.97 | $13.17 – $66.47 | 43,690 | 20 |
| Stoughton, WI | $106.37 | $9.29 – $152.75 | 43,676 | 32 |
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.