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 |
|---|---|---|---|---|
| Sicily Island, LA | $0.99 | $0.00 – $22.53 | 33,413 | 6 |
| Soquel, CA | $29.91 | $0.00 – $99.27 | 33,411 | 22 |
| Havana, IL | $3.64 | $0.24 – $43.88 | 33,410 | 3 |
| Centreville, MD | $86.14 | $18.59 – $122.38 | 33,401 | 19 |
| Redwood Falls, MN | $146.66 | $47.04 – $210.16 | 33,392 | 23 |
| Forestdale, MA | $52.98 | $35.86 – $72.72 | 33,360 | 9 |
| Towanda, PA | $42.81 | $0.00 – $87.19 | 33,357 | 13 |
| Northern Cambria, PA | $42.02 | $36.69 – $42.54 | 33,357 | 3 |
| Mason, WV | $41.85 | $14.20 – $61.85 | 33,309 | 7 |
| Calais, ME | $11.64 | $0.00 – $108.65 | 33,291 | 12 |
| Mebane, NC | $63.71 | $30.72 – $124.89 | 33,281 | 27 |
| Channahon, IL | $48.44 | $0.00 – $68.47 | 33,260 | 16 |
| El Dorado Springs, MO | $27.01 | $4.33 – $109.45 | 33,245 | 16 |
| Jamestown, KY | $34.16 | $21.81 – $36.75 | 33,230 | 8 |
| Loxahatchee Groves, FL | $75.45 | $36.82 – $94.76 | 33,217 | 7 |
| Hightstown, NJ | $8.20 | $8.12 – $59.30 | 33,200 | 2 |
| Fairview, TN | $41.78 | $31.59 – $51.55 | 33,193 | 12 |
| Markham, IL | $49.84 | $45.89 – $49.84 | 33,173 | 2 |
| Anadarko, OK | $310.88 | $2.67 – $652.78 | 33,154 | 15 |
| Fulton, MD | $66.50 | $6.48 – $181.71 | 33,151 | 23 |
| Holdenville, OK | $87.67 | $0.00 – $117.69 | 33,148 | 9 |
| Cicero, NY | $72.97 | $1.23 – $115.13 | 33,143 | 25 |
| Morton, MS | $68.64 | $25.91 – $99.20 | 33,126 | 12 |
| Crandon, WI | $32.97 | $0.00 – $66.88 | 33,116 | 18 |
| Elkridge, MD | $87.94 | $16.05 – $191.39 | 33,103 | 34 |
| Nyc, NY | $60.09 | $6.19 – $132.17 | 33,093 | 7 |
| Altoona, IA | $37.02 | $0.00 – $76.64 | 33,066 | 21 |
| Fort Hood, TX | $46.90 | $0.00 – $654.21 | 33,022 | 29 |
| Weatherford, TX | $45.74 | $7.43 – $596.07 | 33,011 | 37 |
| Wahiawa, HI | $86.71 | $0.00 – $257.19 | 32,990 | 18 |
| Hercules, CA | $32.80 | $0.24 – $58.43 | 32,970 | 4 |
| Frankenmuth, MI | $71.23 | $42.91 – $93.98 | 32,962 | 6 |
| Laurens, SC | $59.62 | $14.24 – $150.91 | 32,957 | 22 |
| Vestavia, AL | $68.53 | $0.96 – $143.34 | 32,957 | 29 |
| White Marsh, MD | $108.67 | $10.25 – $206.52 | 32,942 | 14 |
| Desloge, MO | $42.29 | $32.76 – $70.11 | 32,928 | 4 |
| Collinsville, OK | $81.89 | $48.20 – $99.89 | 32,918 | 11 |
| Ticonderoga, NY | $63.61 | $54.93 – $80.97 | 32,915 | 14 |
| Nevada, IA | $17.20 | $0.00 – $58.97 | 32,908 | 14 |
| South Pittsburg, TN | $43.61 | $32.18 – $52.23 | 32,901 | 8 |
| Copperhill, TN | $38.75 | $5.54 – $50.04 | 32,889 | 8 |
| Lakeville, MA | $45.99 | $31.97 – $65.74 | 32,888 | 12 |
| Bixby, OK | $97.96 | $31.74 – $668.63 | 32,848 | 13 |
| Reserve, LA | $4.30 | $0.00 – $40.77 | 32,846 | 9 |
| Victoria, VA | $46.69 | $18.10 – $66.74 | 32,818 | 12 |
| Pigeon, MI | $19.82 | $0.14 – $51.50 | 32,799 | 3 |
| Choctaw, OK | $69.78 | $14.26 – $140.96 | 32,791 | 13 |
| Romeoville, IL | $14.33 | $0.01 – $114.61 | 32,791 | 11 |
| Elkhorn City, KY | $32.27 | $17.97 – $40.66 | 32,736 | 9 |
| Boyle Heights, CA | $3.97 | $3.97 – $3.97 | 32,734 | 1 |
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.