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 |
|---|---|---|---|---|
| Bailey, MS | $49.22 | $49.22 – $49.22 | 8,573 | 1 |
| Bosque Farms, NM | $101.82 | $100.11 – $105.53 | 8,573 | 2 |
| Cross Plains, TN | $26.43 | $26.43 – $26.43 | 8,574 | 1 |
| Hollis, NH | $64.08 | $46.61 – $64.74 | 8,576 | 2 |
| Plains, PA | $31.56 | $5.19 – $93.70 | 8,576 | 20 |
| Lagrangeville, NY | $79.17 | $73.55 – $112.08 | 8,577 | 6 |
| Boyce, LA | $14.82 | $0.00 – $16.00 | 8,578 | 3 |
| Carolina Beach, NC | $67.12 | $6.47 – $81.50 | 8,583 | 9 |
| Edgefield, SC | $60.86 | $35.45 – $68.25 | 8,585 | 8 |
| Gore, OK | $77.56 | $64.50 – $121.52 | 8,588 | 2 |
| Harned, KY | $28.39 | $28.39 – $28.39 | 8,594 | 1 |
| Harlowton, MT | $5.51 | $0.00 – $99.27 | 8,596 | 4 |
| New Boston, TX | $31.52 | $11.07 – $41.17 | 8,597 | 6 |
| Lisbon, NY | $76.40 | $68.13 – $150.28 | 8,597 | 2 |
| Monticellow, KY | $24.84 | $24.84 – $24.84 | 8,602 | 1 |
| Fultondale, AL | $48.98 | $29.90 – $82.42 | 8,604 | 8 |
| Sheridan, IN | $57.68 | $40.24 – $95.35 | 8,611 | 6 |
| Waldport, OR | $81.96 | $45.84 – $107.64 | 8,614 | 7 |
| San Antonio, PR | $0.01 | $0.00 – $0.02 | 8,614 | 4 |
| Bridgehampton, NY | $35.52 | $1.59 – $86.11 | 8,614 | 2 |
| Copperas Cove, TX | $51.66 | $0.00 – $77.06 | 8,625 | 16 |
| Northfield, OH | $70.03 | $21.64 – $118.45 | 8,628 | 9 |
| Minford, OH | $40.22 | $39.53 – $41.32 | 8,634 | 2 |
| Thermopolis, WY | $4.09 | $0.03 – $56.49 | 8,635 | 10 |
| Superior, CO | $61.23 | $32.39 – $109.50 | 8,636 | 16 |
| Lavonia, GA | $28.17 | $20.36 – $68.35 | 8,641 | 4 |
| New Orlenas, LA | $31.84 | $31.84 – $31.84 | 8,649 | 1 |
| Knoxville, IL | $40.26 | $0.00 – $51.72 | 8,654 | 2 |
| Indpls, IN | $64.33 | $61.79 – $82.19 | 8,656 | 2 |
| Somerdale, NJ | $47.08 | $10.94 – $62.89 | 8,656 | 8 |
| Pulaski, WI | $37.92 | $24.75 – $44.33 | 8,663 | 7 |
| Clawson, MI | $69.92 | $49.91 – $74.13 | 8,682 | 4 |
| Storrs Mansfield, CT | $32.37 | $30.26 – $48.43 | 8,683 | 6 |
| Norwood, CO | $145.25 | $121.94 – $204.08 | 8,684 | 6 |
| Swainsboro, GA | $38.14 | $22.03 – $115.71 | 8,686 | 7 |
| Helper, UT | $57.22 | $5.40 – $66.21 | 8,689 | 3 |
| Mccook, NE | $35.44 | $12.00 – $89.63 | 8,690 | 5 |
| East Machias, ME | $9.22 | $6.34 – $44.40 | 8,694 | 2 |
| Kathleen, GA | $124.61 | $123.91 – $630.00 | 8,696 | 2 |
| Grantsville, MD | $120.47 | $49.11 – $303.28 | 8,698 | 8 |
| Westcliffe, CO | $86.73 | $69.95 – $127.51 | 8,702 | 4 |
| Pounding Mill, VA | $51.05 | $29.83 – $62.98 | 8,704 | 6 |
| Scammon Bay, AK | $253.81 | $42.71 – $440.35 | 8,705 | 7 |
| South Deerfield, MA | $47.39 | $32.18 – $58.04 | 8,706 | 3 |
| Paulding, OH | $38.10 | $14.04 – $49.63 | 8,709 | 8 |
| Vidor, TX | $33.03 | $0.86 – $38.03 | 8,709 | 5 |
| Buena Vista, GA | $81.19 | $39.82 – $115.08 | 8,710 | 4 |
| Santa Claus, IN | $62.09 | $59.55 – $64.78 | 8,710 | 2 |
| Mccall, ID | $33.87 | $0.00 – $82.77 | 8,710 | 15 |
| Onarga, IL | $1.93 | $0.00 – $38.22 | 8,710 | 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.