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 |
|---|---|---|---|---|
| Sanders, AZ | $18.74 | $18.74 – $18.74 | 103 | 1 |
| Dickson Cty, PA | $44.83 | $44.83 – $44.83 | 104 | 1 |
| Johnson, RI | $63.27 | $63.27 – $63.27 | 104 | 1 |
| Malden, WV | $10.64 | $10.64 – $10.64 | 104 | 1 |
| Portland, AR | $11.09 | $0.00 – $16.71 | 104 | 2 |
| Plainview, AR | $12.20 | $5.61 – $26.25 | 104 | 3 |
| Cold Spring, MN | $49.82 | $14.59 – $69.16 | 105 | 4 |
| New England, ND | $142.54 | $142.54 – $142.54 | 106 | 1 |
| Walker, MO | $75.12 | $75.12 – $75.12 | 106 | 1 |
| Mcintosh, SD | $150.16 | $150.16 – $150.16 | 106 | 1 |
| Waashington Court House, OH | $91.80 | $91.80 – $91.80 | 106 | 1 |
| Arnoldsburg, WV | $1.97 | $1.97 – $1.97 | 107 | 1 |
| Hartland, ME | $54.63 | $54.63 – $54.63 | 107 | 1 |
| Nehalem, OR | $72.79 | $72.79 – $72.79 | 107 | 1 |
| Warrenton, NC | $25.04 | $25.04 – $25.04 | 108 | 1 |
| Beech Island, SC | $198.29 | $166.18 – $229.23 | 108 | 2 |
| Greenville, GA | $9.36 | $9.36 – $9.36 | 109 | 1 |
| Urania, LA | $0.00 | $0.00 – $0.00 | 109 | 1 |
| Creedmoor, TX | $7.04 | $7.04 – $7.04 | 109 | 1 |
| Zavalla, TX | $15.09 | $9.45 – $19.53 | 109 | 2 |
| Name, AK | $824.50 | $824.50 – $824.50 | 109 | 1 |
| Deer Park, MD | $123.99 | $123.99 – $123.99 | 109 | 1 |
| Warwich, RI | $45.24 | $45.24 – $45.24 | 110 | 1 |
| Mt Jewett, PA | $4.44 | $4.44 – $4.44 | 110 | 1 |
| Presto, PA | $37.57 | $37.57 – $37.57 | 110 | 1 |
| Missoda, MT | $34.38 | $34.38 – $34.38 | 110 | 1 |
| Wales, AK | $300.62 | $287.55 – $383.40 | 110 | 2 |
| Las Alamitos, CA | $35.58 | $31.50 – $66.29 | 111 | 2 |
| Garden Ridge, TX | $37.10 | $37.10 – $37.10 | 111 | 1 |
| Cape Vincent, NY | $42.21 | $42.21 – $42.21 | 111 | 1 |
| Manhattan Bch, CA | $0.38 | $0.38 – $0.38 | 111 | 1 |
| Port Saint John, FL | $51.63 | $51.63 – $51.63 | 112 | 1 |
| Nulato, AK | $438.74 | $430.77 – $448.63 | 112 | 3 |
| Lake In The Hills, IL | $25.32 | $12.52 – $32.34 | 113 | 2 |
| Corolla, NC | $1.52 | $1.52 – $1.52 | 113 | 1 |
| Morrisdale, PA | $0.00 | $0.00 – $0.00 | 113 | 1 |
| Fountainville, PA | $82.71 | $52.81 – $92.44 | 114 | 2 |
| Keystone, CO | $8.65 | $8.65 – $8.65 | 114 | 1 |
| Mechanicsville, IA | $0.00 | $0.00 – $0.00 | 114 | 1 |
| Roc, IL | $23.84 | $23.84 – $23.84 | 114 | 1 |
| Scio, OR | $76.57 | $76.57 – $76.57 | 114 | 1 |
| Smyrna, SC | $14.79 | $14.79 – $14.79 | 114 | 1 |
| Wells, NV | $38.98 | $38.98 – $38.98 | 115 | 1 |
| Lansing, NC | $42.66 | $42.66 – $42.66 | 115 | 1 |
| Viola, AR | $34.49 | $34.49 – $34.49 | 115 | 1 |
| Mc Guire Afb, NJ | $75.51 | $75.51 – $75.51 | 115 | 1 |
| Jeffersontown, KY | $35.28 | $30.49 – $37.13 | 115 | 2 |
| Dagsboro, DE | $4.85 | $4.85 – $4.85 | 116 | 1 |
| Greely, CO | $63.00 | $63.00 – $63.00 | 116 | 1 |
| Tuxedo Park, NY | $34.47 | $34.47 – $34.47 | 116 | 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.