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 |
|---|---|---|---|---|
| Monrovia, CA | $41.64 | $0.00 – $651.64 | 31,128 | 23 |
| Hawaiian Gardens, CA | $3.62 | $0.00 – $10.64 | 31,117 | 9 |
| E Stroudsburg, PA | $55.56 | $37.70 – $71.40 | 31,110 | 9 |
| Forest Grove, OR | $54.63 | $4.09 – $193.71 | 31,109 | 30 |
| Vermillion, SD | $43.65 | $20.09 – $125.12 | 31,099 | 13 |
| Mount Vernon, MO | $44.80 | $14.35 – $105.87 | 31,095 | 15 |
| Exeter, NH | $37.97 | $0.00 – $144.29 | 31,093 | 93 |
| Marshfield, MO | $42.34 | $3.43 – $174.48 | 31,087 | 20 |
| Wellston, MI | $3.96 | $3.96 – $3.96 | 31,085 | 1 |
| Albia, IA | $2.25 | $0.00 – $52.17 | 31,083 | 4 |
| Weatherford, OK | $99.61 | $38.58 – $214.09 | 31,076 | 21 |
| Mt Pleasant, SC | $56.43 | $7.89 – $312.93 | 31,074 | 70 |
| Gibsonton, FL | $40.01 | $33.94 – $41.67 | 31,072 | 2 |
| Geneva, OH | $37.59 | $21.39 – $100.62 | 31,042 | 21 |
| Paxton, IL | $5.54 | $0.01 – $49.85 | 31,037 | 3 |
| Archdale, NC | $44.36 | $27.37 – $95.00 | 31,003 | 14 |
| Plain Dealing, LA | $1.27 | $0.00 – $1.56 | 30,986 | 3 |
| Pinckneyville, IL | $10.95 | $0.14 – $69.58 | 30,971 | 7 |
| Coventry, RI | $51.62 | $14.54 – $88.86 | 30,948 | 25 |
| Osage, IA | $4.24 | $0.04 – $35.26 | 30,946 | 8 |
| New Carlisle, OH | $52.17 | $0.44 – $74.96 | 30,936 | 11 |
| Nashville, AR | $36.02 | $18.41 – $64.08 | 30,890 | 18 |
| Fredericktown, MO | $65.88 | $15.89 – $167.07 | 30,848 | 21 |
| Pueblo West, CO | $70.31 | $0.00 – $257.71 | 30,842 | 21 |
| Argos, IN | $52.19 | $40.50 – $57.29 | 30,828 | 5 |
| Franklin Furnace, OH | $80.74 | $37.14 – $99.78 | 30,824 | 3 |
| Springfield, VT | $11.45 | $0.00 – $111.15 | 30,811 | 25 |
| Ephrata, WA | $45.67 | $12.74 – $71.71 | 30,806 | 16 |
| Titusville, PA | $15.91 | $0.00 – $54.21 | 30,801 | 22 |
| Ithaca, MI | $36.04 | $34.36 – $38.19 | 30,798 | 2 |
| New Ulm, MN | $66.08 | $0.00 – $331.05 | 30,777 | 53 |
| Camp Verde, AZ | $55.24 | $27.80 – $96.74 | 30,753 | 17 |
| Gloucester City, NJ | $64.93 | $39.40 – $163.91 | 30,732 | 6 |
| Wadena, MN | $171.81 | $10.95 – $235.02 | 30,718 | 33 |
| Malabar, FL | $32.37 | $12.97 – $64.43 | 30,714 | 13 |
| Jefferson, IA | $8.76 | $1.89 – $53.82 | 30,711 | 11 |
| La Vista, NE | $57.19 | $11.48 – $114.78 | 30,684 | 27 |
| Colts Neck, NJ | $58.61 | $10.04 – $104.45 | 30,681 | 13 |
| Spirit Lake, IA | $32.93 | $19.55 – $41.95 | 30,616 | 21 |
| Saddle Brook, NJ | $44.21 | $26.05 – $123.09 | 30,605 | 7 |
| Canton, CT | $43.93 | $0.00 – $80.02 | 30,575 | 12 |
| Plymouth Meeting, PA | $53.35 | $0.00 – $125.39 | 30,559 | 61 |
| Sale Creek, TN | $39.50 | $33.00 – $50.43 | 30,538 | 8 |
| White River Junction, VT | $64.09 | $0.00 – $81.09 | 30,513 | 27 |
| Versailles, MO | $75.68 | $17.65 – $104.28 | 30,507 | 10 |
| Pembroke, MA | $47.30 | $1.85 – $102.14 | 30,505 | 28 |
| Parsons, TN | $35.33 | $14.24 – $44.38 | 30,503 | 9 |
| Carson City, MI | $23.88 | $16.21 – $49.75 | 30,501 | 8 |
| Oakdale, MN | $85.55 | $20.82 – $163.10 | 30,482 | 29 |
| Adamsville, TN | $31.79 | $1.75 – $45.93 | 30,478 | 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.