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 Riverside, IL | $18.68 | $18.68 – $18.68 | 67 | 1 |
| Hortonville, WI | $17.14 | $11.85 – $21.43 | 67 | 2 |
| Leslie, MI | $26.97 | $26.97 – $26.97 | 68 | 1 |
| Accord, MA | $60.36 | $60.36 – $60.36 | 68 | 1 |
| Ellisville, IL | $99.40 | $99.40 – $99.40 | 68 | 1 |
| Sagamore Beach, MA | $85.96 | $29.00 – $100.73 | 68 | 2 |
| Pitman, NJ | $35.08 | $35.08 – $35.08 | 68 | 1 |
| White Settlement, TX | $16.94 | $16.94 – $16.94 | 68 | 1 |
| Shungnak, AK | $367.89 | $352.00 – $371.29 | 68 | 2 |
| Copper Center, AK | $424.23 | $424.23 – $424.23 | 68 | 1 |
| Arccibo, PR | $0.00 | $0.00 – $0.00 | 69 | 1 |
| Stonybrook, NY | $90.81 | $90.81 – $90.81 | 69 | 1 |
| Rougemont, NC | $27.06 | $27.06 – $27.06 | 69 | 1 |
| Washoe Valley, NV | $43.34 | $43.34 – $43.34 | 69 | 1 |
| South Casco, ME | $32.89 | $32.89 – $32.89 | 69 | 1 |
| No Dartmouth, MA | $18.44 | $18.44 – $18.44 | 70 | 1 |
| Milford, VA | $15.08 | $15.08 – $15.08 | 70 | 1 |
| John C Stennis Space Center, MS | $18.04 | $18.04 – $18.04 | 70 | 1 |
| San Francisisco, CA | $0.37 | $0.37 – $0.37 | 70 | 1 |
| Harmony, PA | $41.06 | $41.06 – $41.06 | 70 | 1 |
| Mosca, CO | $216.43 | $216.43 – $216.43 | 71 | 1 |
| Maidsville, WV | $41.95 | $22.66 – $51.23 | 71 | 3 |
| New Castle, ME | $38.74 | $38.74 – $38.74 | 71 | 1 |
| Haxtun, CO | $187.83 | $187.83 – $187.83 | 71 | 1 |
| Lakehills, TX | $30.12 | $30.12 – $30.12 | 71 | 1 |
| Sauk Village, IL | $71.01 | $71.01 – $71.01 | 72 | 1 |
| East Liberty, OH | $42.05 | $42.05 – $42.05 | 72 | 1 |
| Beachwood, NJ | $33.82 | $0.00 – $45.09 | 72 | 2 |
| Murrayville, GA | $454.12 | $454.12 – $454.12 | 72 | 1 |
| Groveland, MA | $25.72 | $25.72 – $25.72 | 72 | 1 |
| Rockton, IL | $106.49 | $106.49 – $106.49 | 72 | 1 |
| Saunderstown, RI | $59.58 | $59.58 – $59.58 | 73 | 1 |
| Wakeforest, NC | $78.81 | $78.81 – $78.81 | 73 | 1 |
| Oak Grove, OR | $44.57 | $44.57 – $44.57 | 73 | 1 |
| Bison, SD | $117.10 | $117.10 – $117.10 | 73 | 1 |
| New Alexandria, PA | $39.64 | $39.64 – $39.64 | 74 | 1 |
| Wilmot, AR | $2.11 | $0.00 – $2.56 | 74 | 2 |
| Lanesboro, MN | $25.33 | $25.33 – $25.33 | 74 | 1 |
| Malad, ID | $4.69 | $4.69 – $4.69 | 74 | 1 |
| Adams Center, NY | $59.10 | $59.10 – $59.10 | 74 | 1 |
| Star, NC | $2.03 | $2.03 – $2.03 | 74 | 1 |
| Mountain City, GA | $53.54 | $53.54 – $53.54 | 75 | 1 |
| Norwood, NJ | $3.58 | $2.62 – $3.78 | 75 | 2 |
| Chenega Bay, AK | $377.59 | $148.01 – $421.32 | 75 | 2 |
| Sicklerville, PA | $6.35 | $6.35 – $6.35 | 75 | 1 |
| Springtown, TX | $0.48 | $0.00 – $0.60 | 75 | 2 |
| Fort Monmouth, NJ | $76.93 | $76.93 – $76.93 | 76 | 1 |
| West Chester, IL | $42.89 | $42.89 – $42.89 | 76 | 1 |
| Greene, ME | $29.30 | $15.98 – $72.21 | 76 | 2 |
| Patton, PA | $19.87 | $13.48 – $42.05 | 76 | 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.