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 |
|---|---|---|---|---|
| Rock Cave, WV | $13.11 | $0.00 – $33.72 | 32,701 | 8 |
| Westmoreland, TN | $33.63 | $14.65 – $57.64 | 32,686 | 14 |
| Fayetteville, WV | $29.77 | $0.00 – $76.55 | 32,658 | 15 |
| Flossmoor, IL | $44.37 | $6.13 – $92.39 | 32,610 | 29 |
| Tonasket, WA | $35.33 | $16.18 – $68.45 | 32,582 | 26 |
| Camp Lejeune, NC | $47.48 | $0.91 – $78.01 | 32,579 | 34 |
| Stowe, VT | $13.29 | $0.00 – $98.62 | 32,559 | 13 |
| Warm Springs, OR | $378.15 | $20.59 – $504.41 | 32,544 | 13 |
| Maumelle, AR | $30.58 | $4.63 – $54.35 | 32,532 | 25 |
| Live Oak, TX | $46.31 | $0.00 – $97.27 | 32,531 | 31 |
| Tylertown, MS | $54.26 | $19.29 – $126.64 | 32,518 | 14 |
| Woodbury, NY | $89.93 | $5.82 – $166.62 | 32,503 | 43 |
| Wolcott, CT | $55.16 | $19.70 – $83.10 | 32,491 | 11 |
| Horse Cave, KY | $34.89 | $18.30 – $42.29 | 32,473 | 6 |
| Wickenburg, AZ | $13.88 | $0.01 – $94.94 | 32,460 | 16 |
| Patton, CA | $77.46 | $0.00 – $144.91 | 32,441 | 13 |
| Kearneysville, WV | $48.89 | $21.77 – $95.87 | 32,428 | 6 |
| Woodbury, TN | $37.71 | $10.38 – $117.80 | 32,428 | 15 |
| Benzonia, MI | $61.14 | $61.14 – $61.14 | 32,414 | 1 |
| Bainbridge Island, WA | $33.37 | $11.95 – $140.03 | 32,413 | 34 |
| Nesconset, NY | $61.98 | $14.81 – $146.37 | 32,407 | 19 |
| Dobson, NC | $68.24 | $24.90 – $98.41 | 32,383 | 10 |
| Islip Terrace, NY | $47.58 | $28.55 – $97.77 | 32,309 | 10 |
| Center Line, MI | $23.45 | $5.17 – $79.57 | 32,292 | 6 |
| Windham, ME | $45.91 | $8.58 – $158.15 | 32,291 | 26 |
| Highland Park, IL | $48.38 | $0.13 – $658.34 | 32,270 | 37 |
| New Providence, NJ | $64.51 | $17.52 – $109.30 | 32,257 | 14 |
| Lakin, KS | $176.31 | $37.13 – $193.90 | 32,246 | 11 |
| Suwanee, GA | $69.25 | $10.79 – $120.61 | 32,225 | 37 |
| Charlton, MA | $39.92 | $5.96 – $75.03 | 32,184 | 26 |
| Whiting, IN | $57.28 | $24.65 – $79.17 | 32,179 | 7 |
| Oakbrook Terrace, IL | $50.94 | $5.57 – $318.75 | 32,179 | 26 |
| Mansfield, MA | $57.55 | $3.72 – $290.68 | 32,145 | 26 |
| Butler, MO | $53.42 | $16.75 – $103.10 | 32,136 | 16 |
| Belgrade, ME | $12.83 | $0.32 – $142.42 | 32,133 | 8 |
| Port St John, FL | $50.85 | $1.24 – $103.43 | 32,117 | 17 |
| Ava, MO | $62.01 | $11.53 – $129.63 | 32,115 | 12 |
| York, SC | $62.87 | $27.08 – $71.86 | 32,067 | 12 |
| Guadalupe, AZ | $0.51 | $0.39 – $18.39 | 32,060 | 4 |
| Borger, TX | $40.88 | $17.15 – $43.97 | 32,056 | 11 |
| Lincoln, CA | $30.93 | $0.00 – $157.33 | 32,054 | 29 |
| Whitfield, MS | $21.15 | $1.27 – $85.36 | 32,053 | 9 |
| Trumann, AR | $35.20 | $8.51 – $48.24 | 32,049 | 13 |
| Westborough, MA | $59.21 | $0.00 – $135.47 | 32,036 | 54 |
| Elizabeth, LA | $1.29 | $0.00 – $9.09 | 32,028 | 5 |
| Whitesboro, NY | $71.18 | $0.00 – $97.45 | 32,024 | 17 |
| Johnston City, IL | $3.35 | $0.00 – $49.44 | 32,012 | 4 |
| Old Saybrook, CT | $43.70 | $0.00 – $82.03 | 32,004 | 25 |
| Larchmont, NY | $84.26 | $0.00 – $256.25 | 31,984 | 26 |
| Dawsonville, GA | $64.00 | $31.88 – $104.21 | 31,968 | 16 |
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.