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 |
|---|---|---|---|---|
| Ringtown, PA | $11.26 | $11.26 – $11.26 | 3,401 | 1 |
| New Salisbury, IN | $46.88 | $37.50 – $47.08 | 3,403 | 2 |
| Winsted, MN | $89.56 | $42.85 – $118.80 | 3,405 | 4 |
| Kotlik, AK | $140.72 | $0.00 – $205.24 | 3,405 | 4 |
| Archer, FL | $30.33 | $0.00 – $37.19 | 3,407 | 7 |
| Erie, KS | $130.35 | $126.58 – $162.72 | 3,411 | 2 |
| Boulder City, NV | $45.95 | $2.03 – $63.99 | 3,412 | 6 |
| South Riding, VA | $71.15 | $63.01 – $84.68 | 3,414 | 3 |
| Ho Ho Kus, NJ | $46.08 | $31.66 – $126.49 | 3,414 | 9 |
| Moundridge, KS | $26.38 | $5.84 – $29.17 | 3,414 | 7 |
| Weyers Cave, VA | $23.62 | $16.27 – $47.38 | 3,415 | 4 |
| Ephraim, UT | $55.25 | $50.62 – $68.01 | 3,418 | 3 |
| Edwardsville, PA | $0.26 | $0.00 – $73.80 | 3,418 | 3 |
| Stuart, IA | $0.13 | $0.00 – $1.43 | 3,419 | 4 |
| Falling Waters, WV | $63.58 | $51.13 – $76.23 | 3,421 | 5 |
| Thorndale, TX | $12.15 | $4.03 – $29.86 | 3,421 | 4 |
| Somerset, OH | $32.48 | $23.13 – $38.21 | 3,421 | 3 |
| Cuero, TX | $25.37 | $19.20 – $48.84 | 3,422 | 6 |
| Marstons Mills, MA | $49.58 | $46.09 – $109.41 | 3,423 | 4 |
| Santa Ynez, CA | $51.49 | $51.49 – $51.49 | 3,426 | 1 |
| Orting, WA | $51.78 | $51.78 – $51.78 | 3,426 | 1 |
| Courtland, AL | $37.00 | $0.00 – $60.22 | 3,430 | 2 |
| Ola, AR | $20.35 | $15.39 – $22.33 | 3,431 | 2 |
| Cambridge Springs, PA | $0.87 | $0.00 – $114.26 | 3,432 | 2 |
| Georgetown, MA | $58.78 | $16.90 – $81.84 | 3,433 | 5 |
| Fort Johnson, LA | $50.84 | $48.85 – $52.42 | 3,438 | 2 |
| Audubon, PA | $46.23 | $45.53 – $49.14 | 3,446 | 2 |
| Greece, NY | $79.10 | $56.60 – $82.94 | 3,449 | 3 |
| Fredricksburg, VA | $55.78 | $52.71 – $68.09 | 3,450 | 2 |
| Lewisberry, PA | $32.12 | $30.43 – $38.07 | 3,451 | 3 |
| Pine Grove, WV | $47.27 | $27.91 – $53.26 | 3,452 | 3 |
| Altoona, AL | $19.93 | $0.00 – $58.10 | 3,452 | 4 |
| Elderton, PA | $0.07 | $0.00 – $15.69 | 3,452 | 4 |
| Poseyville, IN | $48.22 | $37.76 – $54.68 | 3,453 | 2 |
| Grand Island, NY | $43.72 | $1.67 – $68.05 | 3,456 | 5 |
| Altavista, VA | $53.83 | $32.71 – $70.84 | 3,459 | 4 |
| Alger, MI | $36.35 | $30.91 – $44.83 | 3,459 | 2 |
| Dubois, WY | $11.38 | $0.00 – $61.26 | 3,459 | 4 |
| Northome, MN | $60.26 | $60.26 – $60.26 | 3,461 | 1 |
| Tamc, HI | $51.62 | $1.22 – $70.86 | 3,462 | 4 |
| Terra Alta, WV | $47.90 | $47.90 – $47.90 | 3,463 | 1 |
| Richland, MI | $48.33 | $42.84 – $56.58 | 3,467 | 4 |
| Lena, IL | $54.42 | $36.87 – $62.30 | 3,467 | 5 |
| Bee Cave, TX | $42.87 | $13.43 – $180.08 | 3,474 | 7 |
| Mendocino, CA | $1.24 | $0.00 – $46.97 | 3,475 | 3 |
| New Cuyama, CA | $122.48 | $122.48 – $122.48 | 3,475 | 1 |
| Ojo Encino, NM | $149.68 | $149.68 – $149.68 | 3,477 | 1 |
| Dudley, MA | $44.47 | $25.37 – $51.77 | 3,478 | 3 |
| Fort Yukon, AK | $422.38 | $32.21 – $733.37 | 3,482 | 3 |
| N Caldwell, NJ | $37.48 | $37.48 – $37.48 | 3,482 | 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.