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 |
|---|---|---|---|---|
| Krotz Springs, LA | $0.29 | $0.00 – $0.37 | 3,823 | 2 |
| Wakefield, NE | $50.62 | $36.72 – $61.97 | 3,825 | 2 |
| Royse City, TX | $37.80 | $7.70 – $58.21 | 3,830 | 5 |
| Waterford, NY | $61.31 | $30.52 – $83.03 | 3,833 | 4 |
| Zebulon, GA | $67.66 | $37.59 – $81.49 | 3,834 | 3 |
| Parkville, MO | $49.64 | $25.90 – $86.61 | 3,839 | 8 |
| La Cygne, KS | $170.73 | $129.23 – $201.54 | 3,839 | 3 |
| Chester, CT | $45.58 | $6.61 – $62.47 | 3,839 | 4 |
| Ft Wainwright, AK | $263.85 | $24.43 – $650.87 | 3,841 | 5 |
| Algoma, WI | $44.97 | $22.08 – $63.88 | 3,844 | 7 |
| Montgomery, NY | $73.53 | $17.62 – $121.79 | 3,844 | 5 |
| Marcellus, MI | $63.79 | $63.79 – $63.79 | 3,844 | 1 |
| Crescent, OK | $44.97 | $7.57 – $116.12 | 3,844 | 4 |
| Conroy, SC | $55.81 | $55.81 – $55.81 | 3,847 | 1 |
| Seymour, MO | $61.00 | $39.60 – $89.37 | 3,849 | 5 |
| Pine Hill, AL | $1.80 | $0.00 – $1.94 | 3,850 | 2 |
| Pelham, NH | $39.23 | $19.92 – $74.23 | 3,850 | 8 |
| South Hero, VT | $33.84 | $0.00 – $87.43 | 3,854 | 4 |
| Imperial, NE | $109.05 | $27.47 – $120.58 | 3,857 | 6 |
| Saint Michael, MN | $71.90 | $19.64 – $140.81 | 3,860 | 11 |
| Kinsley, KS | $159.49 | $0.00 – $203.15 | 3,860 | 4 |
| Brook Park, OH | $31.25 | $31.25 – $31.25 | 3,861 | 1 |
| Florala, AL | $17.61 | $14.02 – $100.70 | 3,861 | 2 |
| Meade, KS | $130.07 | $18.98 – $134.32 | 3,861 | 2 |
| Tabor, IA | $0.97 | $0.00 – $1.59 | 3,863 | 3 |
| Panhandle, TX | $37.69 | $18.14 – $64.19 | 3,864 | 4 |
| Hanson, MA | $45.34 | $43.23 – $59.65 | 3,866 | 4 |
| Ocean Isle Beach, NC | $26.94 | $0.00 – $52.92 | 3,867 | 3 |
| Oak Hill, OH | $50.71 | $31.13 – $51.17 | 3,870 | 2 |
| Pine River, MN | $53.07 | $49.62 – $58.59 | 3,871 | 5 |
| Locust Valley, NY | $101.14 | $57.73 – $119.01 | 3,871 | 6 |
| Bradford, AR | $42.80 | $27.45 – $43.39 | 3,872 | 2 |
| Salida, CA | $65.13 | $59.29 – $65.34 | 3,873 | 2 |
| Edgewood, Nm, NM | $71.99 | $71.99 – $71.99 | 3,876 | 1 |
| Dundee, MI | $67.44 | $67.44 – $67.44 | 3,881 | 1 |
| Northvale, NJ | $81.02 | $11.78 – $89.68 | 3,881 | 3 |
| Hazlehurst, GA | $49.29 | $27.93 – $91.29 | 3,885 | 5 |
| Oswego, KS | $69.20 | $17.54 – $150.56 | 3,887 | 6 |
| Ingleside, IL | $64.01 | $39.12 – $78.42 | 3,887 | 2 |
| Lee, ME | $1.33 | $1.33 – $1.33 | 3,888 | 1 |
| New Haven, WV | $59.13 | $59.13 – $59.13 | 3,889 | 1 |
| Wakeeney, KS | $104.68 | $0.00 – $118.65 | 3,889 | 2 |
| Pembroke Pnes, FL | $37.22 | $37.22 – $37.22 | 3,889 | 1 |
| Bartonville, IL | $49.99 | $44.20 – $60.33 | 3,889 | 4 |
| Ada, MI | $60.10 | $58.02 – $83.05 | 3,897 | 3 |
| Dalton, MA | $28.80 | $5.04 – $61.08 | 3,898 | 4 |
| Woodstock, MD | $106.15 | $106.15 – $106.15 | 3,898 | 1 |
| Parkers Prairie, MN | $60.30 | $30.67 – $63.69 | 3,899 | 4 |
| Cliffisde Park, NJ | $46.14 | $46.14 – $46.14 | 3,899 | 1 |
| Upper Chichester, PA | $36.68 | $36.68 – $36.68 | 3,900 | 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.