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 |
|---|---|---|---|---|
| Carbondale, PA | $13.94 | $0.04 – $58.69 | 31,968 | 14 |
| Pampa, TX | $28.69 | $0.00 – $62.65 | 31,944 | 27 |
| Charleston, MS | $49.52 | $8.35 – $85.14 | 31,929 | 9 |
| Woodworth, LA | $3.61 | $0.00 – $85.00 | 31,923 | 6 |
| Mayville, NY | $69.17 | $62.80 – $74.07 | 31,878 | 6 |
| Brigantine, NJ | $64.49 | $31.22 – $455.00 | 31,818 | 6 |
| Cranberry Twp, PA | $47.37 | $5.84 – $67.48 | 31,818 | 19 |
| Evans, GA | $60.78 | $11.66 – $260.00 | 31,804 | 30 |
| Gibsonia, PA | $64.39 | $21.31 – $72.34 | 31,793 | 19 |
| Alturas, CA | $13.61 | $0.00 – $469.00 | 31,788 | 16 |
| North Bend, OR | $22.54 | $0.79 – $165.05 | 31,781 | 22 |
| West Brentwood, NY | $205.36 | $58.20 – $242.38 | 31,774 | 6 |
| North Franklin, CT | $23.87 | $13.37 – $59.59 | 31,758 | 22 |
| Lepanto, AR | $35.64 | $22.48 – $36.81 | 31,752 | 5 |
| Princeton, IN | $51.39 | $15.22 – $120.72 | 31,746 | 23 |
| Bellaire, OH | $66.56 | $12.09 – $113.15 | 31,727 | 14 |
| Gibson City, IL | $36.88 | $0.00 – $108.14 | 31,668 | 30 |
| Tecumseh, MI | $38.63 | $0.00 – $90.42 | 31,667 | 11 |
| Delhi, NY | $29.90 | $0.01 – $176.60 | 31,652 | 8 |
| East Dundee, IL | $44.27 | $0.00 – $58.44 | 31,621 | 7 |
| Labelle, FL | $37.39 | $0.00 – $150.09 | 31,595 | 17 |
| Union, WV | $11.78 | $0.00 – $15.93 | 31,585 | 6 |
| Bradford, PA | $30.29 | $0.00 – $139.61 | 31,577 | 40 |
| Girard, OH | $36.92 | $18.64 – $52.36 | 31,529 | 11 |
| Germantown, WI | $34.21 | $16.32 – $67.45 | 31,497 | 43 |
| Burns, OR | $31.18 | $7.89 – $177.31 | 31,476 | 21 |
| Firestone, CO | $75.75 | $44.68 – $136.62 | 31,439 | 21 |
| Eden Prairie, MN | $78.62 | $13.87 – $241.85 | 31,437 | 80 |
| Woodland, WA | $58.09 | $0.00 – $120.20 | 31,400 | 11 |
| Burke, VA | $61.29 | $0.00 – $327.62 | 31,394 | 34 |
| Trenton, OH | $36.74 | $1.39 – $61.07 | 31,366 | 13 |
| Winston, OR | $57.61 | $43.04 – $215.19 | 31,320 | 10 |
| Saluda, SC | $61.80 | $48.11 – $170.17 | 31,309 | 13 |
| Valley Center, CA | $0.53 | $0.00 – $29.28 | 31,303 | 12 |
| Alma, AR | $40.30 | $23.58 – $50.76 | 31,298 | 7 |
| Saint Albans, NY | $64.20 | $0.00 – $120.30 | 31,294 | 17 |
| Montevideo, MN | $59.98 | $8.99 – $276.93 | 31,286 | 33 |
| Macungie, PA | $19.04 | $0.82 – $124.09 | 31,272 | 25 |
| Steele, MO | $42.87 | $40.94 – $90.30 | 31,271 | 2 |
| Harlem, MT | $8.29 | $0.00 – $640.00 | 31,269 | 6 |
| Coeur D'Alene, ID | $67.28 | $26.67 – $83.15 | 31,245 | 14 |
| Souderton, PA | $47.98 | $0.01 – $128.83 | 31,213 | 12 |
| Rigby, ID | $35.87 | $1.48 – $98.91 | 31,201 | 20 |
| Mill Creek, WV | $8.98 | $0.00 – $68.96 | 31,197 | 14 |
| Elizabeth, WV | $28.38 | $0.00 – $75.62 | 31,187 | 13 |
| North East, PA | $29.86 | $1.36 – $56.34 | 31,184 | 11 |
| Haddon Township, NJ | $54.90 | $3.09 – $343.43 | 31,178 | 11 |
| Georgiana, AL | $3.20 | $0.00 – $33.18 | 31,164 | 8 |
| Hart, MI | $3.06 | $1.09 – $23.29 | 31,163 | 4 |
| Belmond, IA | $8.90 | $0.00 – $49.44 | 31,158 | 13 |
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.