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 |
|---|---|---|---|---|
| Senturce, PR | $1.56 | $1.56 – $1.56 | 94 | 1 |
| Worthington, PA | $25.54 | $22.37 – $42.19 | 94 | 2 |
| Hagatna, GU | $60.39 | $53.17 – $81.44 | 94 | 2 |
| Cusseta, AL | $12.01 | $12.01 – $12.01 | 94 | 1 |
| Fontana, WI | $16.46 | $16.46 – $16.46 | 94 | 1 |
| Helvetia, WV | $52.33 | $52.33 – $52.33 | 94 | 1 |
| Bloomingdale, NJ | $27.93 | $27.93 – $27.93 | 95 | 1 |
| Newton, UT | $0.00 | $0.00 – $0.00 | 95 | 1 |
| W Coxsackie, NY | $90.11 | $8.17 – $103.10 | 95 | 2 |
| Bollivia, NC | $32.78 | $32.78 – $32.78 | 95 | 1 |
| Winfield, IA | $0.00 | $0.00 – $0.00 | 96 | 1 |
| North Palm Bch, FL | $96.98 | $96.98 – $96.98 | 96 | 1 |
| Lyman, SC | $64.23 | $64.23 – $64.23 | 96 | 1 |
| Newton, TX | $19.27 | $0.02 – $27.20 | 96 | 2 |
| Fallsington, PA | $17.50 | $17.50 – $17.50 | 96 | 1 |
| Waterford Township, MI | $48.18 | $48.18 – $48.18 | 97 | 1 |
| Galatia, IL | $35.63 | $35.63 – $35.63 | 97 | 1 |
| Wilsall, MT | $0.00 | $0.00 – $0.00 | 98 | 1 |
| Toadlena, NM | $160.66 | $160.66 – $160.66 | 98 | 1 |
| Panacea, FL | $28.14 | $28.14 – $28.14 | 98 | 1 |
| Cave City, AR | $34.96 | $34.96 – $34.96 | 98 | 1 |
| Holly Pond, AL | $55.77 | $55.77 – $55.77 | 98 | 1 |
| Pelham Manor, NY | $64.97 | $64.97 – $64.97 | 99 | 1 |
| Lavaca, AR | $34.42 | $34.42 – $34.42 | 99 | 1 |
| Chignik, AK | $0.00 | $0.00 – $0.00 | 99 | 1 |
| Huntington Valley, PA | $43.01 | $43.01 – $43.01 | 99 | 1 |
| Bellmawr, NJ | $0.00 | $0.00 – $0.00 | 99 | 1 |
| Loup City, NE | $117.95 | $117.95 – $117.95 | 99 | 1 |
| Homer, GA | $116.06 | $100.91 – $122.48 | 99 | 3 |
| Pittsgrove, NJ | $18.35 | $18.35 – $18.35 | 100 | 1 |
| Acushnet, MA | $41.97 | $41.97 – $41.97 | 100 | 1 |
| Fremont, WI | $23.44 | $23.44 – $23.44 | 100 | 1 |
| Crystal City, MO | $104.86 | $104.86 – $104.86 | 100 | 1 |
| Hodgkins, IL | $2.59 | $2.59 – $2.59 | 100 | 1 |
| Sealevel, NC | $56.11 | $56.11 – $56.11 | 100 | 1 |
| South Portland, Me 04106, ME | $42.70 | $42.70 – $42.70 | 101 | 1 |
| Kirland, WA | $84.90 | $84.90 – $84.90 | 101 | 1 |
| Allentown, NJ | $41.88 | $38.34 – $50.66 | 101 | 2 |
| Gainesville, NY | $68.01 | $68.01 – $68.01 | 101 | 1 |
| N. Augusta, SC | $43.08 | $43.08 – $43.08 | 102 | 1 |
| Topton, PA | $47.91 | $47.74 – $49.00 | 102 | 2 |
| West Middlesex, PA | $31.75 | $31.75 – $31.75 | 102 | 1 |
| New Jersey, NY | $0.00 | $0.00 – $0.00 | 102 | 1 |
| Millfield, OH | $22.98 | $22.98 – $22.98 | 102 | 1 |
| Swanzey, NH | $48.06 | $48.06 – $48.06 | 103 | 1 |
| Sanders, AZ | $18.74 | $18.74 – $18.74 | 103 | 1 |
| Golovin, AK | $440.38 | $436.18 – $444.04 | 103 | 3 |
| Jaspe, GA | $24.69 | $24.69 – $24.69 | 103 | 1 |
| Sharon, SC | $38.32 | $22.69 – $52.51 | 103 | 2 |
| Ft Wayne, IN | $1.86 | $1.86 – $1.86 | 103 | 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.