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 |
|---|---|---|---|---|
| Baldwin Place, NY | $93.74 | $93.74 – $93.74 | 5,748 | 1 |
| Upland, IN | $55.69 | $32.62 – $119.88 | 5,750 | 7 |
| Ryan, OK | $99.54 | $64.02 – $205.61 | 5,750 | 3 |
| Ossipee, NH | $42.29 | $9.33 – $53.72 | 5,752 | 4 |
| Greenport, NY | $119.34 | $69.05 – $162.07 | 5,756 | 7 |
| Coleman, TX | $41.60 | $32.57 – $64.51 | 5,757 | 3 |
| Byram Township, NJ | $72.03 | $63.53 – $79.51 | 5,758 | 2 |
| Crossville, AL | $42.56 | $42.47 – $45.18 | 5,778 | 3 |
| Boyertown, PA | $31.82 | $0.00 – $56.84 | 5,779 | 8 |
| Baraga, MI | $12.91 | $12.91 – $12.91 | 5,781 | 1 |
| Imperial, MO | $58.29 | $45.28 – $100.45 | 5,781 | 9 |
| Deer River, MN | $57.89 | $41.27 – $77.31 | 5,784 | 12 |
| Hewitt, NJ | $64.37 | $39.17 – $69.72 | 5,790 | 3 |
| Lk Havasu Cty, AZ | $65.20 | $65.20 – $65.20 | 5,790 | 1 |
| Old Hickory, TN | $24.90 | $9.43 – $42.98 | 5,791 | 6 |
| Columbia, NJ | $22.91 | $18.07 – $123.09 | 5,794 | 4 |
| Tonopah, NV | $48.87 | $29.21 – $68.73 | 5,797 | 4 |
| Early, TX | $40.25 | $23.51 – $40.64 | 5,805 | 3 |
| Gainesboro, TN | $26.68 | $4.27 – $29.45 | 5,822 | 2 |
| Winterhaven, CA | $32.01 | $0.00 – $68.47 | 5,824 | 6 |
| Auburn, IL | $42.38 | $42.38 – $42.38 | 5,827 | 1 |
| Gt Barrington, MA | $66.02 | $8.14 – $202.69 | 5,839 | 9 |
| Bainbridge, IN | $54.66 | $46.59 – $67.89 | 5,842 | 7 |
| Wrangell, AK | $225.82 | $24.56 – $622.32 | 5,842 | 6 |
| Sutton, MA | $73.97 | $13.12 – $121.06 | 5,842 | 8 |
| Wharton, NJ | $44.82 | $44.82 – $44.82 | 5,845 | 1 |
| Cedar Grove, WV | $9.72 | $0.00 – $10.20 | 5,848 | 3 |
| Waitsburg, WA | $45.72 | $20.82 – $52.35 | 5,848 | 3 |
| Queens, NY | $41.75 | $0.00 – $111.29 | 5,850 | 11 |
| Thurmont, MD | $80.44 | $8.11 – $111.00 | 5,852 | 6 |
| Toney, AL | $50.22 | $0.35 – $71.66 | 5,855 | 4 |
| Pink Hill, NC | $49.72 | $46.79 – $50.09 | 5,856 | 3 |
| St Marys, KS | $145.91 | $145.91 – $145.91 | 5,859 | 1 |
| Bayboro, NC | $38.41 | $25.64 – $55.94 | 5,860 | 9 |
| Fillmore, UT | $62.41 | $47.83 – $92.49 | 5,860 | 8 |
| Walnut, MS | $34.60 | $26.76 – $44.05 | 5,860 | 3 |
| Bedford, IA | $1.24 | $0.00 – $31.71 | 5,861 | 4 |
| Mossyrock, WA | $43.88 | $28.40 – $46.85 | 5,865 | 5 |
| Seneca, KS | $192.68 | $17.90 – $221.93 | 5,866 | 3 |
| Wellfleet, MA | $38.72 | $11.52 – $84.12 | 5,873 | 6 |
| Port Sulphur, LA | $51.98 | $51.98 – $51.98 | 5,879 | 1 |
| Strattanville, PA | $0.03 | $0.03 – $0.03 | 5,881 | 1 |
| Westport, NY | $51.11 | $51.11 – $51.11 | 5,883 | 1 |
| Akron, IN | $47.83 | $0.00 – $79.30 | 5,885 | 6 |
| Park City, IL | $38.13 | $6.99 – $99.86 | 5,887 | 5 |
| Frenchtown, MT | $80.53 | $77.55 – $90.03 | 5,888 | 2 |
| Bonneau, SC | $63.77 | $45.82 – $65.19 | 5,889 | 2 |
| Fredericksburg, PA | $43.38 | $0.00 – $69.14 | 5,890 | 11 |
| Monticello, UT | $63.32 | $3.64 – $122.71 | 5,891 | 6 |
| Glenmora, LA | $20.60 | $20.50 – $20.79 | 5,892 | 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.