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 |
|---|---|---|---|---|
| Herkimer, NY | $62.37 | $0.00 – $140.35 | 41,408 | 28 |
| Ishpeming, MI | $61.65 | $15.78 – $61.79 | 41,375 | 5 |
| St Johns, FL | $64.66 | $0.00 – $83.71 | 41,354 | 15 |
| Hurst, TX | $44.46 | $3.99 – $86.48 | 41,350 | 29 |
| Morrisville, NC | $60.50 | $1.52 – $101.89 | 41,348 | 41 |
| Stratham, NH | $47.37 | $0.80 – $77.80 | 41,346 | 28 |
| Decherd, TN | $38.39 | $15.08 – $60.21 | 41,343 | 13 |
| Mt Pleasant, IA | $32.12 | $0.00 – $72.75 | 41,339 | 23 |
| Rocky River, OH | $41.33 | $0.00 – $88.41 | 41,330 | 44 |
| North Highlands, CA | $18.71 | $0.00 – $448.23 | 41,304 | 18 |
| Webster Springs, WV | $16.49 | $0.00 – $52.88 | 41,285 | 16 |
| Marshall, IL | $9.46 | $0.00 – $62.78 | 41,263 | 6 |
| Everett, PA | $58.63 | $11.77 – $82.52 | 41,258 | 23 |
| Winchester, MA | $100.19 | $0.00 – $174.07 | 41,242 | 42 |
| Livermore Falls, ME | $25.46 | $0.33 – $494.40 | 41,221 | 11 |
| Princeton, KY | $31.49 | $18.05 – $51.72 | 41,220 | 21 |
| Crestwood, KY | $49.72 | $23.94 – $84.49 | 41,218 | 20 |
| Wilton, CT | $54.54 | $16.42 – $153.99 | 41,207 | 46 |
| Paoli, IN | $53.77 | $13.06 – $85.29 | 41,180 | 15 |
| Jonesville, MI | $57.42 | $1.36 – $59.54 | 41,177 | 4 |
| Bellmore, NY | $79.15 | $26.22 – $212.66 | 41,134 | 30 |
| Dededo, GU | $77.96 | $16.11 – $104.44 | 41,070 | 30 |
| Hadley, MA | $100.49 | $25.19 – $546.89 | 41,070 | 17 |
| Allen, KY | $31.59 | $30.73 – $37.63 | 41,063 | 2 |
| Litchfield, MN | $147.15 | $14.66 – $226.41 | 41,043 | 21 |
| Barrington, RI | $68.23 | $28.89 – $108.94 | 41,017 | 30 |
| Crystal River, FL | $36.78 | $0.00 – $183.70 | 40,980 | 49 |
| Pflugerville, TX | $42.42 | $0.64 – $377.82 | 40,957 | 38 |
| Waynesville, NC | $46.99 | $0.00 – $255.75 | 40,940 | 36 |
| Eufaula, AL | $77.76 | $0.00 – $203.94 | 40,932 | 17 |
| Shakopee, MN | $69.38 | $12.17 – $448.26 | 40,931 | 75 |
| Ventnor, NJ | $61.79 | $38.02 – $75.00 | 40,889 | 3 |
| Richton, MS | $67.21 | $15.81 – $115.40 | 40,880 | 8 |
| Snowflake, AZ | $53.60 | $0.00 – $101.70 | 40,851 | 19 |
| Frackville, PA | $28.87 | $0.00 – $64.32 | 40,840 | 14 |
| Newton, NC | $61.47 | $6.59 – $333.30 | 40,819 | 26 |
| Holden, MA | $68.87 | $26.83 – $106.08 | 40,797 | 35 |
| Navarre, FL | $44.52 | $9.81 – $67.67 | 40,784 | 27 |
| Eagar, AZ | $50.77 | $0.00 – $57.84 | 40,761 | 8 |
| Colchester, VT | $37.10 | $0.00 – $526.22 | 40,752 | 48 |
| Craig, CO | $204.65 | $0.00 – $372.36 | 40,725 | 34 |
| Sturtevant, WI | $47.09 | $0.02 – $55.54 | 40,712 | 6 |
| Chiefland, FL | $51.08 | $20.78 – $671.61 | 40,705 | 14 |
| Tonawanda, NY | $49.49 | $8.12 – $156.62 | 40,649 | 41 |
| Shawnee, KS | $41.39 | $2.19 – $282.32 | 40,647 | 58 |
| Mamaroneck, NY | $75.11 | $31.52 – $148.01 | 40,642 | 29 |
| Evarts, KY | $25.71 | $14.91 – $31.89 | 40,610 | 7 |
| Highland, MI | $59.81 | $45.12 – $76.20 | 40,604 | 8 |
| Moss Point, MS | $76.28 | $0.00 – $312.61 | 40,592 | 30 |
| Pepper Pike, OH | $57.33 | $19.85 – $116.57 | 40,582 | 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.