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 |
|---|---|---|---|---|
| Zuni, NM | $81.41 | $0.31 – $307.19 | 38,389 | 23 |
| Arkadelphia, AR | $33.26 | $0.00 – $46.40 | 38,384 | 24 |
| Heavener, OK | $90.35 | $10.27 – $654.00 | 38,369 | 6 |
| Rutherford College, NC | $64.03 | $20.60 – $73.20 | 38,361 | 7 |
| Prospect, KY | $41.92 | $21.43 – $62.44 | 38,359 | 21 |
| Powhatan, VA | $55.08 | $13.91 – $99.52 | 38,310 | 16 |
| Ventnor City, NJ | $53.53 | $3.49 – $94.62 | 38,305 | 12 |
| Clarkston, GA | $46.57 | $1.46 – $75.73 | 38,302 | 10 |
| Hawkinsville, GA | $79.48 | $15.45 – $113.54 | 38,191 | 6 |
| Scappoose, OR | $70.60 | $11.32 – $91.70 | 38,186 | 21 |
| Grapevine, TX | $44.59 | $0.00 – $110.45 | 38,182 | 31 |
| Dadeville, AL | $12.58 | $0.00 – $187.92 | 38,159 | 13 |
| Gering, NE | $61.16 | $26.50 – $221.40 | 38,137 | 18 |
| Cornelius, NC | $47.58 | $0.00 – $103.23 | 38,137 | 54 |
| Hiawatha, KS | $94.89 | $0.00 – $156.86 | 38,133 | 17 |
| Houston, MS | $58.77 | $0.00 – $137.34 | 38,096 | 29 |
| Saint Helens, OR | $60.92 | $0.00 – $1,300 | 38,081 | 26 |
| Azle, TX | $36.25 | $0.00 – $42.97 | 38,075 | 23 |
| Whiteland, IN | $55.59 | $39.17 – $85.40 | 38,041 | 18 |
| Eureka, MT | $30.46 | $0.00 – $99.52 | 38,025 | 7 |
| Ganado, AZ | $70.43 | $7.02 – $109.52 | 37,999 | 12 |
| Mokena, IL | $51.88 | $2.91 – $97.46 | 37,975 | 55 |
| N Chelmsford, MA | $43.53 | $16.34 – $75.10 | 37,973 | 32 |
| Tuskegee, AL | $55.06 | $0.00 – $207.06 | 37,972 | 11 |
| Two Rivers, WI | $26.90 | $6.91 – $49.79 | 37,933 | 46 |
| Napoleon, OH | $55.51 | $1.85 – $196.43 | 37,916 | 27 |
| Marlboro, NJ | $38.82 | $0.00 – $127.08 | 37,906 | 22 |
| Morrisonville, NY | $101.00 | $46.20 – $101.13 | 37,889 | 3 |
| La Mirada, CA | $18.31 | $0.00 – $81.67 | 37,873 | 24 |
| Snow Hill, MD | $76.18 | $15.53 – $81.35 | 37,862 | 6 |
| Franklin, NH | $56.48 | $0.00 – $272.60 | 37,859 | 22 |
| Center Moriches, NY | $56.40 | $29.65 – $155.98 | 37,859 | 14 |
| Newbury Park, CA | $3.62 | $0.00 – $76.18 | 37,849 | 11 |
| Decorah, IA | $51.56 | $10.30 – $263.73 | 37,829 | 41 |
| Waynesboro, PA | $36.44 | $0.00 – $110.56 | 37,795 | 34 |
| Colbert, GA | $100.71 | $90.25 – $121.61 | 37,757 | 11 |
| Clintwood, VA | $60.42 | $15.87 – $112.22 | 37,748 | 20 |
| Harrisonville, MO | $52.34 | $3.29 – $117.26 | 37,747 | 24 |
| Ladysmith, WI | $51.33 | $12.25 – $119.99 | 37,735 | 34 |
| Buckeye, WV | $45.85 | $0.00 – $74.66 | 37,720 | 14 |
| North Attleboro, MA | $43.90 | $8.01 – $73.44 | 37,715 | 27 |
| Lockport, IL | $52.93 | $15.88 – $64.98 | 37,697 | 11 |
| Taylor Mill, KY | $43.29 | $34.55 – $47.96 | 37,679 | 8 |
| Huntsville, TX | $37.72 | $0.00 – $134.70 | 37,642 | 35 |
| Mint Hill, NC | $59.68 | $5.37 – $111.12 | 37,633 | 30 |
| Larose, LA | $0.20 | $0.00 – $1.91 | 37,610 | 6 |
| Oak Bluffs, MA | $47.59 | $0.00 – $298.26 | 37,587 | 41 |
| Glasgow, MT | $7.21 | $0.00 – $404.67 | 37,570 | 9 |
| Hoquiam, WA | $45.50 | $0.00 – $111.39 | 37,569 | 12 |
| Merrimack, NH | $41.11 | $20.43 – $80.56 | 37,562 | 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.