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 |
|---|---|---|---|---|
| N Easton, MA | $41.48 | $34.94 – $54.00 | 3,557 | 2 |
| Sante Fe, NM | $88.72 | $72.77 – $106.86 | 3,558 | 3 |
| Lyndora, PA | $36.58 | $32.54 – $55.60 | 3,560 | 3 |
| Grabill, IN | $54.88 | $40.23 – $73.78 | 3,567 | 4 |
| Hialeah Gardens, FL | $37.01 | $0.00 – $105.30 | 3,567 | 8 |
| Athens, WV | $5.98 | $0.00 – $28.94 | 3,567 | 5 |
| Groveland, CA | $38.30 | $34.51 – $60.73 | 3,567 | 2 |
| Unalaska, AK | $454.19 | $55.14 – $620.36 | 3,569 | 5 |
| Cohasset, MA | $43.06 | $0.00 – $80.80 | 3,571 | 14 |
| Maple Glen, PA | $43.96 | $43.96 – $43.96 | 3,575 | 1 |
| Jane Lew, WV | $77.13 | $40.59 – $89.81 | 3,577 | 6 |
| Lynx, OH | $32.12 | $32.12 – $32.12 | 3,578 | 1 |
| Woodside, CA | $40.10 | $0.00 – $40.25 | 3,579 | 3 |
| Bondville, VT | $0.27 | $0.27 – $0.27 | 3,580 | 1 |
| Beaverton, AL | $47.98 | $47.98 – $47.98 | 3,580 | 1 |
| Millbrae, CA | $19.56 | $0.26 – $122.05 | 3,582 | 3 |
| Waynoka, OK | $82.90 | $75.99 – $99.76 | 3,585 | 2 |
| Kings Mtn, NC | $68.69 | $68.69 – $68.69 | 3,586 | 1 |
| Granville, IL | $51.94 | $46.07 – $57.71 | 3,586 | 3 |
| Sandy Lake, PA | $0.11 | $0.00 – $0.15 | 3,588 | 2 |
| Edgard, LA | $0.07 | $0.00 – $0.07 | 3,589 | 2 |
| Harlingent, TX | $48.45 | $48.45 – $48.45 | 3,590 | 1 |
| Ponderay, ID | $53.20 | $43.44 – $75.58 | 3,591 | 5 |
| Ringwood, NJ | $47.53 | $44.44 – $55.50 | 3,593 | 2 |
| Madisonville, TX | $39.78 | $0.00 – $63.83 | 3,594 | 5 |
| Greenville, CA | $10.78 | $1.72 – $22.27 | 3,597 | 3 |
| South Hutchinson, KS | $86.80 | $86.80 – $86.80 | 3,597 | 1 |
| Madison, NJ | $48.46 | $25.66 – $60.83 | 3,600 | 6 |
| Tyler, MN | $134.89 | $56.54 – $181.01 | 3,600 | 8 |
| Highmount, NY | $64.04 | $64.04 – $64.04 | 3,601 | 1 |
| Dell Rapids, SD | $36.90 | $22.54 – $37.71 | 3,608 | 2 |
| Florence, WI | $29.30 | $9.63 – $36.51 | 3,610 | 5 |
| Wells, ME | $32.38 | $16.87 – $59.17 | 3,610 | 7 |
| Mendham, NJ | $35.25 | $35.25 – $35.25 | 3,612 | 1 |
| Vandalia, MO | $71.75 | $33.38 – $88.85 | 3,619 | 2 |
| Randle, WA | $36.83 | $5.37 – $54.93 | 3,620 | 4 |
| Oasis, ID | $53.22 | $53.22 – $53.22 | 3,623 | 1 |
| Tamworth, NH | $45.41 | $45.41 – $45.41 | 3,625 | 1 |
| Ronda, NC | $29.68 | $23.85 – $43.66 | 3,625 | 4 |
| St. Martinville, LA | $29.07 | $0.00 – $30.81 | 3,627 | 2 |
| Cherry Point, NC | $57.77 | $0.80 – $62.58 | 3,630 | 5 |
| Wesley Hills, NY | $79.80 | $79.80 – $79.80 | 3,631 | 1 |
| Lakeland, GA | $51.08 | $51.08 – $51.08 | 3,631 | 1 |
| Carbondale, KS | $54.27 | $30.37 – $96.37 | 3,631 | 6 |
| Lindsborg, KS | $87.63 | $11.56 – $683.10 | 3,633 | 7 |
| E Syracuse, NY | $52.79 | $41.16 – $63.59 | 3,634 | 4 |
| St Albans, NY | $59.70 | $59.70 – $59.70 | 3,635 | 1 |
| Ravenna, MI | $65.29 | $65.28 – $65.30 | 3,636 | 2 |
| Arnold, CA | $26.65 | $25.17 – $32.56 | 3,638 | 3 |
| Manteo, NC | $58.75 | $17.71 – $98.01 | 3,639 | 8 |
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.