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 |
|---|---|---|---|---|
| Manorville, NY | $77.89 | $56.35 – $122.29 | 15,965 | 9 |
| Linthicum, MD | $90.23 | $2.86 – $122.71 | 15,968 | 11 |
| Brownsville, CA | $37.02 | $1.34 – $37.99 | 15,972 | 3 |
| Cottage Grove, MN | $81.75 | $6.58 – $137.31 | 15,980 | 30 |
| York, AL | $28.12 | $0.00 – $115.35 | 15,992 | 6 |
| West Grove, PA | $60.71 | $0.53 – $113.82 | 16,015 | 26 |
| Marianna, AR | $32.17 | $15.49 – $37.75 | 16,025 | 5 |
| Great Falls, VA | $14.70 | $0.03 – $195.12 | 16,025 | 5 |
| Glen Rock, NJ | $50.82 | $0.00 – $180.53 | 16,043 | 8 |
| Strong, ME | $1.47 | $0.83 – $292.62 | 16,066 | 2 |
| Romulus, MI | $63.35 | $14.64 – $85.78 | 16,082 | 6 |
| Osgood, IN | $51.34 | $45.66 – $58.35 | 16,110 | 8 |
| Sandstone, MN | $69.98 | $49.42 – $627.36 | 16,117 | 14 |
| Lemoyne, PA | $80.08 | $0.00 – $148.45 | 16,118 | 21 |
| Bethel, OH | $33.33 | $18.95 – $52.96 | 16,122 | 5 |
| Sisters, OR | $71.79 | $0.00 – $118.31 | 16,130 | 13 |
| Tamaqua, PA | $38.09 | $0.53 – $124.60 | 16,131 | 11 |
| Napoleonville, LA | $45.13 | $0.00 – $73.10 | 16,144 | 3 |
| Angels Camp, CA | $20.83 | $2.99 – $39.85 | 16,166 | 7 |
| China Grove, NC | $50.55 | $0.15 – $67.00 | 16,170 | 11 |
| Bronxville, NY | $80.69 | $22.66 – $219.75 | 16,178 | 41 |
| Laurel Fork, VA | $50.00 | $33.07 – $75.93 | 16,185 | 10 |
| Berlin, CT | $59.91 | $31.69 – $81.34 | 16,186 | 11 |
| Goleta, CA | $102.65 | $0.00 – $211.50 | 16,189 | 18 |
| Manville, NJ | $43.60 | $4.37 – $55.63 | 16,190 | 4 |
| Englewood, FL | $59.46 | $0.00 – $710.89 | 16,194 | 15 |
| Rochelle, GA | $119.80 | $109.38 – $432.61 | 16,197 | 2 |
| Aston, PA | $38.52 | $15.75 – $50.06 | 16,201 | 10 |
| Torrington, WY | $21.78 | $0.00 – $90.96 | 16,203 | 15 |
| Ellington, CT | $29.37 | $13.04 – $52.58 | 16,203 | 6 |
| Milton, DE | $37.13 | $0.47 – $134.80 | 16,210 | 17 |
| Pierre Part, LA | $4.15 | $0.00 – $39.54 | 16,219 | 4 |
| Heber City, UT | $57.82 | $6.15 – $90.62 | 16,222 | 22 |
| East Lyme, CT | $56.94 | $17.34 – $82.81 | 16,226 | 12 |
| Shavertown, PA | $34.04 | $11.61 – $44.88 | 16,233 | 10 |
| Dinwiddie, VA | $64.06 | $14.07 – $111.11 | 16,234 | 7 |
| Garberville, CA | $1.58 | $0.00 – $57.97 | 16,258 | 7 |
| Higginsville, MO | $39.92 | $0.93 – $126.64 | 16,261 | 8 |
| Grundy Center, IA | $8.25 | $0.00 – $44.29 | 16,265 | 7 |
| Blountville, TN | $42.35 | $30.10 – $50.07 | 16,268 | 5 |
| Northfield, MN | $72.88 | $25.35 – $112.19 | 16,272 | 45 |
| Lanse, MI | $33.89 | $3.72 – $58.91 | 16,273 | 4 |
| Ulysses, KS | $196.51 | $14.64 – $221.85 | 16,281 | 5 |
| Gloucester, NJ | $30.34 | $1.98 – $30.60 | 16,288 | 2 |
| Puryear, TN | $50.40 | $50.40 – $50.40 | 16,292 | 1 |
| Murphys, CA | $18.93 | $0.00 – $123.00 | 16,300 | 3 |
| Lewistown, IL | $0.02 | $0.02 – $0.02 | 16,309 | 1 |
| Worland, WY | $48.72 | $0.36 – $284.18 | 16,310 | 15 |
| Grantsburg, WI | $54.00 | $31.07 – $106.62 | 16,315 | 14 |
| Houlka, MS | $60.86 | $13.99 – $111.19 | 16,319 | 6 |
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.