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 |
|---|---|---|---|---|
| Blue Point, NY | $9.92 | $9.92 – $9.92 | 45 | 1 |
| Williamson, GA | $14.67 | $14.67 – $14.67 | 45 | 1 |
| La Belle, MO | $300.57 | $300.57 – $300.57 | 45 | 1 |
| Edwards, CA | $68.37 | $68.37 – $68.37 | 45 | 1 |
| Auburn, NH | $115.44 | $115.44 – $115.44 | 46 | 1 |
| Walnut Creek, CT | $2.28 | $2.28 – $2.28 | 46 | 1 |
| Mullen, NE | $62.75 | $57.97 – $74.88 | 46 | 2 |
| Mcdermitt, NV | $9.82 | $0.00 – $28.24 | 46 | 2 |
| Pinconning, MI | $46.18 | $46.18 – $46.18 | 46 | 1 |
| Bahama, NC | $102.08 | $94.93 – $112.24 | 46 | 2 |
| Saint Francis, MN | $21.20 | $21.20 – $21.20 | 46 | 1 |
| W Hollywood, CA | $96.85 | $96.85 – $96.85 | 46 | 1 |
| Worcesster, MA | $7.25 | $7.25 – $7.25 | 47 | 1 |
| Us Air Force, CO | $40.25 | $40.25 – $40.25 | 47 | 1 |
| Quanah, TX | $56.20 | $56.20 – $56.20 | 47 | 1 |
| Bogata, TX | $23.75 | $23.75 – $23.75 | 47 | 1 |
| Payne, OH | $37.64 | $37.64 – $37.64 | 47 | 1 |
| Danvers, IL | $58.62 | $58.62 – $58.62 | 47 | 1 |
| Tyngsboro, MA | $59.43 | $59.43 – $59.43 | 47 | 1 |
| Surprize, AZ | $56.92 | $56.92 – $56.92 | 47 | 1 |
| Wisner, NE | $101.94 | $39.95 – $130.99 | 47 | 2 |
| Berlin Heights, OH | $65.24 | $65.24 – $65.24 | 47 | 1 |
| Conway, MO | $22.19 | $22.19 – $22.19 | 47 | 1 |
| Warfordsburg, PA | $106.31 | $106.31 – $106.31 | 48 | 1 |
| East Gull Lake, MN | $59.60 | $59.60 – $59.60 | 48 | 1 |
| Walker, WV | $18.17 | $18.17 – $18.17 | 48 | 1 |
| Fair Oaks Ranch, TX | $6.26 | $6.26 – $6.26 | 48 | 1 |
| Saint Paul Island, AK | $372.36 | $372.36 – $372.36 | 48 | 1 |
| Joint Base Mdl, NJ | $21.85 | $21.85 – $21.85 | 49 | 1 |
| Alma, CO | $65.33 | $65.33 – $65.33 | 49 | 1 |
| Moriches, NY | $36.57 | $36.57 – $36.57 | 49 | 1 |
| Tysons Corner, VA | $0.00 | $0.00 – $0.00 | 49 | 1 |
| Worcerster, MA | $66.55 | $66.55 – $66.55 | 50 | 1 |
| Bront, NY | $69.51 | $69.51 – $69.51 | 50 | 1 |
| Byers, CO | $25.47 | $25.47 – $25.47 | 50 | 1 |
| Crestline, CA | $14.64 | $12.44 – $20.30 | 50 | 2 |
| Gainesville Fl, FL | $20.88 | $20.88 – $20.88 | 50 | 1 |
| Blufton, SC | $46.57 | $46.57 – $46.57 | 51 | 1 |
| Tetlin, AK | $429.01 | $429.01 – $429.01 | 51 | 1 |
| South Toms River, NJ | $38.97 | $38.97 – $38.97 | 51 | 1 |
| Danville, NH | $50.97 | $50.97 – $50.97 | 52 | 1 |
| Nenana, AK | $413.63 | $413.63 – $413.63 | 52 | 1 |
| Morristown, NY | $29.46 | $29.46 – $29.46 | 52 | 1 |
| Troy, ID | $0.47 | $0.47 – $0.47 | 52 | 1 |
| Haworth, NJ | $0.57 | $0.57 – $0.57 | 52 | 1 |
| Poynette, WI | $12.87 | $10.56 – $19.80 | 52 | 2 |
| Mosier, OR | $29.84 | $29.84 – $29.84 | 52 | 1 |
| Durham, ME | $15.56 | $15.56 – $15.56 | 53 | 1 |
| South Hackensack, NJ | $30.06 | $30.06 – $30.06 | 53 | 1 |
| Eggertsville, NY | $75.79 | $75.79 – $75.79 | 53 | 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.