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 |
|---|---|---|---|---|
| Cut Bank, MT | $2.23 | $0.00 – $102.36 | 34,152 | 6 |
| Jacksonville, AL | $70.94 | $13.69 – $76.01 | 34,145 | 16 |
| Montville, NJ | $25.12 | $12.54 – $58.42 | 34,139 | 13 |
| Carrboro, NC | $54.87 | $0.39 – $98.70 | 34,108 | 14 |
| Iota, LA | $13.76 | $0.00 – $39.37 | 34,032 | 6 |
| Hartford, MI | $6.89 | $0.82 – $53.00 | 34,019 | 4 |
| Hamlet, NC | $47.51 | $0.00 – $81.92 | 33,997 | 14 |
| Pine Prairie, LA | $13.14 | $0.00 – $60.42 | 33,983 | 4 |
| Chaska, MN | $65.54 | $11.51 – $136.44 | 33,972 | 41 |
| Sierra Madre, CA | $74.56 | $20.40 – $86.49 | 33,954 | 3 |
| Cockeysville, MD | $83.88 | $19.29 – $214.01 | 33,953 | 15 |
| Destin, FL | $54.55 | $0.00 – $104.08 | 33,938 | 23 |
| Concord Twp, OH | $47.37 | $20.89 – $126.75 | 33,920 | 23 |
| West Linn, OR | $72.89 | $8.35 – $119.44 | 33,912 | 27 |
| Foothill Ranch, CA | $22.42 | $0.00 – $151.90 | 33,899 | 19 |
| York, NE | $62.44 | $17.41 – $93.02 | 33,878 | 21 |
| Westwood, NJ | $55.46 | $2.53 – $125.80 | 33,863 | 22 |
| Austin, MN | $59.32 | $0.00 – $207.15 | 33,850 | 61 |
| Crookston, MN | $124.11 | $6.20 – $274.36 | 33,812 | 32 |
| Lancaster, WI | $56.32 | $0.47 – $129.21 | 33,796 | 31 |
| Auburn, KY | $29.98 | $27.60 – $37.41 | 33,778 | 6 |
| Winona, MN | $52.21 | $18.21 – $127.40 | 33,777 | 56 |
| Bangor, MI | $10.10 | $0.15 – $201.40 | 33,755 | 5 |
| Safety Harbor, FL | $50.91 | $1.64 – $96.31 | 33,736 | 27 |
| Stafford, TX | $31.00 | $0.00 – $106.42 | 33,727 | 20 |
| Oberlin, OH | $47.06 | $4.17 – $82.12 | 33,689 | 18 |
| Tappahannock, VA | $56.76 | $20.71 – $80.45 | 33,681 | 26 |
| Mcpherson, KS | $95.31 | $10.57 – $217.53 | 33,675 | 25 |
| Hayes, VA | $62.65 | $26.36 – $82.46 | 33,670 | 12 |
| Oxford, CT | $57.75 | $14.83 – $79.66 | 33,644 | 12 |
| N Hollywood, CA | $8.60 | $0.23 – $117.70 | 33,640 | 11 |
| Fort Polk, LA | $79.20 | $0.01 – $1,801 | 33,630 | 15 |
| Rockville, IN | $53.11 | $3.26 – $69.66 | 33,628 | 12 |
| Landover, MD | $84.72 | $11.61 – $141.71 | 33,622 | 15 |
| Science Hill, KY | $32.07 | $18.60 – $39.41 | 33,608 | 5 |
| Central Falls, RI | $51.27 | $4.41 – $90.13 | 33,594 | 9 |
| Scarbro, WV | $16.72 | $15.74 – $32.35 | 33,585 | 3 |
| Wharton, TX | $27.47 | $0.00 – $54.12 | 33,562 | 20 |
| Mangonia Park, FL | $88.51 | $1.28 – $126.27 | 33,554 | 14 |
| Rosebud, SD | $395.90 | $35.67 – $640.00 | 33,537 | 4 |
| Westfield, NJ | $55.85 | $1.82 – $170.07 | 33,531 | 42 |
| Riverton, WY | $34.35 | $0.00 – $85.63 | 33,511 | 27 |
| Manistique, MI | $36.25 | $35.35 – $36.43 | 33,506 | 2 |
| Erwin, NC | $44.20 | $18.05 – $64.48 | 33,492 | 17 |
| Berkeley Springs, WV | $27.70 | $0.10 – $62.92 | 33,486 | 17 |
| Carlisle, KY | $31.14 | $21.02 – $88.95 | 33,480 | 10 |
| Plantsville, CT | $46.98 | $3.79 – $58.57 | 33,470 | 15 |
| Wofford Heights, CA | $11.91 | $7.34 – $22.58 | 33,446 | 3 |
| Sedro Woolley, WA | $52.30 | $0.00 – $72.90 | 33,443 | 19 |
| Gatesville, TX | $43.96 | $0.00 – $127.58 | 33,441 | 28 |
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.