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 |
|---|---|---|---|---|
| Monette, AR | $33.09 | $33.09 – $33.09 | 3,482 | 1 |
| Robinsonville, MS | $40.32 | $35.56 – $69.27 | 3,485 | 3 |
| Hensonville, NY | $82.36 | $71.68 – $89.83 | 3,485 | 2 |
| Mountain Village, AK | $206.80 | $0.00 – $430.90 | 3,492 | 4 |
| Anton Chico, NM | $139.54 | $139.54 – $139.54 | 3,493 | 1 |
| Tuntutuliak, AK | $340.19 | $6.89 – $471.07 | 3,499 | 3 |
| Ft Mcpherson, GA | $47.54 | $47.54 – $47.54 | 3,501 | 1 |
| Charlestown, RI | $153.17 | $0.00 – $297.26 | 3,502 | 8 |
| Bicknell, IN | $39.56 | $39.29 – $62.34 | 3,502 | 2 |
| Tuttle, OK | $99.79 | $76.91 – $115.31 | 3,503 | 5 |
| Dieterich, IL | $0.00 | $0.00 – $0.00 | 3,504 | 2 |
| Okarche, OK | $83.27 | $76.39 – $90.98 | 3,505 | 2 |
| Twentynine Palms, CA | $40.76 | $0.00 – $108.48 | 3,508 | 10 |
| Downsville, LA | $0.02 | $0.02 – $0.02 | 3,510 | 1 |
| Fort Myers Beach, FL | $54.53 | $42.12 – $78.40 | 3,510 | 3 |
| Shell Knob, MO | $78.20 | $50.97 – $110.11 | 3,510 | 6 |
| Lampasas, TX | $33.11 | $0.00 – $298.94 | 3,512 | 5 |
| Westville, IN | $36.38 | $34.24 – $63.23 | 3,515 | 3 |
| Social Circle, GA | $57.96 | $26.50 – $58.51 | 3,515 | 2 |
| Dozier, AL | $0.00 | $0.00 – $0.00 | 3,516 | 1 |
| Williston, SC | $129.32 | $118.81 – $134.11 | 3,519 | 3 |
| Roebuck, SC | $64.62 | $38.86 – $64.98 | 3,520 | 2 |
| Rangeley, ME | $5.57 | $1.88 – $56.34 | 3,521 | 2 |
| Sumner, IA | $28.28 | $9.11 – $33.64 | 3,522 | 7 |
| Atkins, AR | $25.35 | $18.68 – $28.28 | 3,523 | 3 |
| Kenhorst, PA | $41.37 | $41.37 – $41.37 | 3,524 | 1 |
| Pawling, NY | $116.45 | $111.62 – $124.18 | 3,525 | 3 |
| Canton, SD | $44.43 | $35.60 – $44.46 | 3,525 | 2 |
| Na'Alehu, HI | $167.99 | $143.96 – $191.67 | 3,525 | 2 |
| Queenstown, MD | $78.50 | $2.81 – $120.03 | 3,527 | 11 |
| Shippenville, PA | $35.85 | $35.57 – $36.29 | 3,528 | 3 |
| Universal City, CA | $0.06 | $0.01 – $0.12 | 3,528 | 2 |
| Dushore, PA | $62.07 | $62.07 – $62.07 | 3,530 | 1 |
| Halifax, PA | $39.16 | $0.00 – $53.88 | 3,530 | 4 |
| Walworth, WI | $34.75 | $19.88 – $55.83 | 3,534 | 5 |
| Bolton, CT | $44.48 | $8.02 – $55.45 | 3,535 | 5 |
| Lemmon, SD | $85.96 | $85.96 – $85.96 | 3,535 | 1 |
| Merillville, IL | $28.01 | $28.01 – $28.01 | 3,535 | 1 |
| Union Mills, IN | $63.05 | $63.05 – $63.05 | 3,536 | 1 |
| Hoodsport, WA | $55.28 | $45.74 – $87.03 | 3,536 | 3 |
| West View, PA | $50.09 | $46.84 – $52.65 | 3,537 | 2 |
| Allardt, TN | $37.99 | $37.99 – $37.99 | 3,539 | 1 |
| Hampton, NJ | $61.40 | $0.00 – $80.45 | 3,542 | 8 |
| Breckenridge, CO | $54.32 | $0.00 – $81.06 | 3,547 | 7 |
| Lino Lakes, MN | $73.28 | $23.50 – $257.77 | 3,549 | 15 |
| City Of Commerce, CA | $421.63 | $421.63 – $421.63 | 3,551 | 1 |
| Rowley, MA | $47.55 | $3.92 – $66.39 | 3,552 | 6 |
| Troutman, NC | $45.63 | $29.94 – $63.66 | 3,552 | 7 |
| Drums, PA | $33.43 | $1.13 – $33.75 | 3,554 | 3 |
| Keyport, NJ | $16.77 | $0.29 – $18.66 | 3,554 | 2 |
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.