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 |
|---|---|---|---|---|
| Sea Cliff, NY | $66.68 | $65.27 – $124.40 | 4,543 | 2 |
| Elk Rapids, MI | $59.00 | $44.19 – $61.88 | 4,545 | 2 |
| Wanaque, NJ | $71.39 | $70.89 – $74.75 | 4,547 | 2 |
| Aica, HI | $37.66 | $37.66 – $37.66 | 4,548 | 1 |
| New Preston, CT | $73.90 | $68.37 – $143.76 | 4,552 | 2 |
| Dunnville, KY | $45.22 | $45.22 – $45.22 | 4,554 | 1 |
| Orange Grove, TX | $19.28 | $10.40 – $30.09 | 4,557 | 3 |
| Itta Bena, MS | $31.07 | $14.90 – $34.83 | 4,562 | 3 |
| New Bloomfield, PA | $39.64 | $39.63 – $40.29 | 4,564 | 2 |
| Tohatchi, NM | $105.10 | $29.56 – $106.99 | 4,565 | 3 |
| Port Isabel, TX | $28.36 | $0.00 – $28.76 | 4,565 | 3 |
| Peterson Afb, CO | $76.89 | $63.23 – $83.33 | 4,566 | 5 |
| Kingston, RI | $64.29 | $31.93 – $75.97 | 4,566 | 6 |
| Mexia, TX | $48.95 | $32.25 – $67.82 | 4,569 | 6 |
| Pisgah Forest, NC | $45.98 | $28.29 – $58.77 | 4,572 | 2 |
| West Liberty, IA | $24.08 | $13.01 – $29.96 | 4,577 | 4 |
| Bicknell, UT | $50.23 | $5.86 – $108.47 | 4,579 | 2 |
| Florence, CO | $74.13 | $47.29 – $80.02 | 4,581 | 4 |
| Clayton, AL | $42.31 | $0.00 – $188.33 | 4,582 | 3 |
| Bowler, WI | $26.88 | $24.62 – $37.95 | 4,583 | 5 |
| Playa Del Rey, CA | $4.29 | $4.29 – $4.29 | 4,584 | 1 |
| Dunseith, ND | $162.78 | $137.20 – $206.18 | 4,584 | 2 |
| Sedan, KS | $120.72 | $98.29 – $140.67 | 4,586 | 3 |
| Carnegie, OK | $79.72 | $3.05 – $437.55 | 4,587 | 4 |
| Walpole, NH | $20.24 | $4.88 – $46.62 | 4,588 | 3 |
| Sherman, ME | $38.63 | $21.10 – $47.82 | 4,591 | 3 |
| Hayden Lake, ID | $6.80 | $6.00 – $52.04 | 4,592 | 2 |
| Montvale, NJ | $56.60 | $22.31 – $120.40 | 4,594 | 10 |
| Sublimity, OR | $40.79 | $16.95 – $64.85 | 4,595 | 6 |
| Sheridan, OR | $49.57 | $49.57 – $49.57 | 4,598 | 1 |
| Bolton Landing, NY | $69.95 | $42.68 – $86.65 | 4,600 | 4 |
| Betsy Layne, KY | $38.52 | $38.52 – $38.52 | 4,602 | 1 |
| Evans Mills, NY | $47.63 | $43.61 – $67.57 | 4,604 | 5 |
| Graettinger, IA | $0.11 | $0.11 – $0.11 | 4,607 | 1 |
| Deposit, NY | $62.16 | $46.31 – $67.08 | 4,607 | 5 |
| Shamokin Dam, PA | $37.92 | $28.56 – $38.09 | 4,609 | 2 |
| Dumas, TX | $29.10 | $1.88 – $71.10 | 4,610 | 11 |
| Schulenburg, TX | $30.51 | $24.70 – $105.19 | 4,618 | 4 |
| Middlesex, NC | $60.57 | $55.13 – $78.64 | 4,618 | 3 |
| Secane, PA | $18.58 | $6.24 – $21.54 | 4,618 | 3 |
| Pinedale, CA | $42.22 | $0.00 – $56.31 | 4,618 | 2 |
| Rios Piedras, PR | $19.26 | $19.26 – $19.26 | 4,619 | 1 |
| Mont Vernon, NH | $79.78 | $79.78 – $79.78 | 4,620 | 1 |
| North Carrollton, MS | $40.82 | $18.79 – $51.93 | 4,628 | 3 |
| Cherryvale, KS | $110.25 | $28.30 – $145.30 | 4,632 | 6 |
| Millstadt, IL | $1.10 | $0.00 – $37.22 | 4,634 | 2 |
| Hill City, KS | $115.10 | $15.58 – $136.95 | 4,634 | 3 |
| Chelan Falls, WA | $14.42 | $14.42 – $14.42 | 4,635 | 1 |
| Youngsville, NC | $40.60 | $15.84 – $75.71 | 4,636 | 5 |
| Woodstock, CT | $40.80 | $0.00 – $42.72 | 4,637 | 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.