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 |
|---|---|---|---|---|
| Hartselle, AL | $43.55 | $0.00 – $76.86 | 37,514 | 28 |
| Needham, MA | $90.94 | $4.87 – $165.92 | 37,496 | 59 |
| Mc Arthur, OH | $21.21 | $1.39 – $26.21 | 37,494 | 6 |
| Hutto, TX | $35.15 | $12.07 – $62.97 | 37,488 | 15 |
| Glendive, MT | $16.08 | $0.00 – $122.07 | 37,484 | 13 |
| Jackson, AL | $23.85 | $0.00 – $77.62 | 37,461 | 11 |
| Virginia, IL | $24.37 | $0.38 – $59.60 | 37,438 | 7 |
| Sterling, CO | $126.83 | $0.00 – $235.80 | 37,437 | 28 |
| Windsor, CO | $69.87 | $11.51 – $203.21 | 37,426 | 42 |
| Bonita Springs, FL | $32.14 | $0.44 – $132.20 | 37,404 | 34 |
| Sherwood, OR | $75.15 | $2.05 – $170.16 | 37,386 | 35 |
| Bastian, VA | $39.31 | $0.99 – $75.43 | 37,354 | 17 |
| Red Lake, MN | $401.95 | $0.00 – $681.29 | 37,321 | 14 |
| Stillwater, MN | $52.44 | $1.75 – $211.93 | 37,314 | 96 |
| Castleton, NY | $66.06 | $26.87 – $98.97 | 37,303 | 39 |
| La Joya, TX | $22.98 | $11.30 – $24.35 | 37,269 | 3 |
| Dracut, MA | $47.92 | $18.49 – $85.16 | 37,223 | 19 |
| Blackwood, NJ | $80.61 | $7.35 – $292.94 | 37,205 | 21 |
| Pinson, AL | $70.15 | $14.09 – $152.71 | 37,193 | 6 |
| Shippensburg, PA | $47.44 | $0.00 – $149.24 | 37,163 | 23 |
| Carrollton, KY | $35.13 | $7.19 – $60.39 | 37,147 | 20 |
| Floyd, VA | $57.41 | $27.59 – $242.50 | 37,146 | 18 |
| Conneaut, OH | $38.60 | $7.86 – $111.43 | 37,119 | 19 |
| Honaker, VA | $54.76 | $26.77 – $67.32 | 37,068 | 5 |
| Faribault, MN | $66.64 | $12.80 – $153.81 | 37,036 | 49 |
| Santa Fe Springs, CA | $114.06 | $0.00 – $643.57 | 37,003 | 19 |
| Peridot, AZ | $102.41 | $7.22 – $108.74 | 37,002 | 9 |
| Mt Pleasant, TX | $44.80 | $4.53 – $89.66 | 36,993 | 11 |
| East Bridgewater, MA | $39.56 | $0.00 – $83.55 | 36,953 | 45 |
| Poplarville, MS | $79.83 | $12.37 – $282.19 | 36,888 | 20 |
| Cambridge City, IN | $62.98 | $41.31 – $75.59 | 36,875 | 6 |
| Peebles, OH | $38.20 | $36.18 – $44.20 | 36,846 | 5 |
| Glendale Heights, IL | $55.88 | $24.83 – $66.41 | 36,830 | 9 |
| Vergennes, VT | $64.82 | $17.21 – $79.90 | 36,810 | 10 |
| Evergreen, CO | $71.79 | $15.03 – $199.60 | 36,800 | 25 |
| Pedro, OH | $27.96 | $0.00 – $121.53 | 36,786 | 26 |
| Melrose, MA | $52.79 | $5.32 – $449.47 | 36,750 | 47 |
| Merrick, NY | $70.74 | $0.00 – $157.72 | 36,716 | 29 |
| Chavies, KY | $34.88 | $28.57 – $40.34 | 36,708 | 2 |
| Enosburg Falls, VT | $17.00 | $0.41 – $26.88 | 36,674 | 9 |
| Waimanalo, HI | $125.42 | $19.46 – $304.88 | 36,667 | 12 |
| Sandy, OR | $78.38 | $54.05 – $159.97 | 36,657 | 29 |
| Rancho Palos Verdes, CA | $3.96 | $0.00 – $123.41 | 36,649 | 14 |
| Somerset, PA | $40.65 | $4.00 – $154.43 | 36,611 | 41 |
| Cranford, NJ | $52.73 | $7.96 – $106.20 | 36,601 | 21 |
| Plainview, TX | $27.89 | $0.00 – $74.74 | 36,600 | 26 |
| Somers, NY | $80.02 | $4.56 – $210.24 | 36,578 | 17 |
| Rich, VA | $62.40 | $62.40 – $62.40 | 36,515 | 1 |
| Johns Creek, GA | $70.81 | $0.00 – $135.45 | 36,485 | 26 |
| Hillsville, VA | $59.46 | $13.58 – $113.79 | 36,475 | 15 |
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.