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 |
|---|---|---|---|---|
| Shoreview, MN | $47.39 | $3.99 – $95.47 | 16,320 | 31 |
| Tripler Army Medical Center, HI | $60.53 | $0.00 – $276.29 | 16,332 | 32 |
| Ruckersville, VA | $63.62 | $24.11 – $88.55 | 16,340 | 15 |
| Wesley Chapel, NC | $62.95 | $47.69 – $84.05 | 16,342 | 9 |
| Farragut, TN | $44.54 | $12.33 – $59.71 | 16,348 | 17 |
| Ellenville, NY | $69.17 | $0.00 – $182.77 | 16,358 | 12 |
| Esmont, VA | $59.20 | $47.34 – $75.74 | 16,370 | 6 |
| Altadena, CA | $95.85 | $0.00 – $1,233 | 16,374 | 8 |
| Eminence, KY | $39.00 | $13.11 – $59.07 | 16,386 | 7 |
| Jackson, MO | $59.30 | $19.84 – $76.13 | 16,389 | 14 |
| White Oak, PA | $59.95 | $1.01 – $80.94 | 16,393 | 19 |
| Crystal Springs, MS | $47.13 | $10.94 – $86.88 | 16,402 | 7 |
| Bellport, NY | $68.00 | $14.45 – $82.78 | 16,414 | 10 |
| Locust, NC | $55.02 | $29.97 – $71.78 | 16,422 | 12 |
| Pittsburgh, CA | $0.05 | $0.05 – $0.05 | 16,423 | 1 |
| Little Neck, NY | $82.87 | $18.30 – $146.20 | 16,425 | 10 |
| Clairton, PA | $52.63 | $0.74 – $89.97 | 16,427 | 30 |
| Glenpool, OK | $78.10 | $30.68 – $122.64 | 16,427 | 11 |
| Vinton, VA | $55.28 | $16.73 – $74.47 | 16,428 | 14 |
| Lowell, IN | $56.43 | $51.60 – $86.39 | 16,437 | 9 |
| Camp Pendleton, CA | $65.47 | $0.88 – $434.90 | 16,440 | 19 |
| Roan Mountain, TN | $32.34 | $22.06 – $48.15 | 16,459 | 6 |
| Cocoa Beach, FL | $54.83 | $1.75 – $85.20 | 16,474 | 19 |
| Glen Morgan, WV | $58.54 | $52.36 – $82.53 | 16,478 | 2 |
| Reading, MA | $46.15 | $0.00 – $75.62 | 16,482 | 34 |
| Tanner, AL | $5.72 | $0.00 – $62.98 | 16,484 | 4 |
| Clinchco, VA | $49.29 | $46.64 – $49.30 | 16,485 | 2 |
| Pearsall, TX | $27.20 | $0.71 – $48.37 | 16,493 | 8 |
| Johnson, VT | $66.35 | $65.79 – $66.62 | 16,497 | 3 |
| Versailles, OH | $23.80 | $3.45 – $43.68 | 16,498 | 6 |
| West Valley, UT | $92.69 | $35.55 – $159.50 | 16,506 | 9 |
| Kingsford, MI | $259.68 | $0.00 – $261.74 | 16,514 | 3 |
| Bristol, VT | $14.15 | $0.00 – $80.18 | 16,514 | 14 |
| South Abington Township, PA | $44.95 | $20.49 – $55.52 | 16,522 | 10 |
| New York City, NY | $97.59 | $13.03 – $133.01 | 16,533 | 20 |
| Pinon, AZ | $127.83 | $0.94 – $275.05 | 16,534 | 7 |
| Providence, UT | $50.47 | $9.58 – $96.19 | 16,543 | 27 |
| Nitro, WV | $37.21 | $19.17 – $86.10 | 16,554 | 20 |
| Sterling Hts, MI | $59.53 | $34.75 – $80.40 | 16,555 | 5 |
| Jefferson, WI | $13.89 | $8.78 – $58.33 | 16,559 | 10 |
| Red Bud, IL | $12.84 | $0.00 – $130.51 | 16,563 | 6 |
| Ogema, MN | $288.53 | $15.67 – $908.57 | 16,570 | 18 |
| Lakeside Park, KY | $41.37 | $31.21 – $118.84 | 16,570 | 11 |
| Bristow, VA | $66.20 | $12.80 – $83.24 | 16,586 | 14 |
| Orwigsburg, PA | $45.29 | $11.26 – $78.33 | 16,593 | 13 |
| Friendship, WI | $87.34 | $0.59 – $181.03 | 16,597 | 20 |
| Sebree, KY | $32.24 | $21.32 – $59.96 | 16,601 | 7 |
| Barnesville, GA | $61.87 | $22.42 – $74.65 | 16,612 | 8 |
| Haysi, VA | $59.63 | $27.17 – $75.92 | 16,620 | 6 |
| Marlette, MI | $18.60 | $2.32 – $65.75 | 16,625 | 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.