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 |
|---|---|---|---|---|
| Warren, VT | $1.25 | $1.25 – $1.25 | 13 | 1 |
| Clearwater Beach, FL | $94.85 | $94.85 – $94.85 | 13 | 1 |
| Somerville, TX | $27.84 | $27.84 – $27.84 | 13 | 1 |
| Fort Bidwell, CA | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Gordon, TX | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Mt Vernon, AL | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Hershery, PA | $26.45 | $26.45 – $26.45 | 13 | 1 |
| Fowler, KS | $25.92 | $25.92 – $25.92 | 13 | 1 |
| Boise, IN | $53.36 | $53.36 – $53.36 | 13 | 1 |
| Kernerville, NC | $62.41 | $62.41 – $62.41 | 13 | 1 |
| Norwich, VT | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Sperry, IA | $0.00 | $0.00 – $0.00 | 13 | 1 |
| East Hills, NY | $51.39 | $51.39 – $51.39 | 13 | 1 |
| Loyalton, CA | $36.71 | $36.71 – $36.71 | 13 | 1 |
| Alexandria, AL | $23.94 | $23.94 – $23.94 | 13 | 1 |
| Delton, MI | $0.37 | $0.37 – $0.37 | 13 | 1 |
| Watsoville, CA | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Northwood, IA | $32.87 | $32.87 – $32.87 | 13 | 1 |
| Millington, NJ | $16.55 | $16.55 – $16.55 | 13 | 1 |
| Crawforsville, IN | $69.97 | $69.97 – $69.97 | 13 | 1 |
| Hebbronville, TX | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Osmond, NE | $114.59 | $114.59 – $114.59 | 13 | 1 |
| Mcgrath, AK | $577.08 | $577.08 – $577.08 | 13 | 1 |
| Holcomb, KS | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Kirkville, NY | $44.05 | $44.05 – $44.05 | 13 | 1 |
| East Winthrop, ME | $7.02 | $7.02 – $7.02 | 13 | 1 |
| Arnold, NE | $113.92 | $113.92 – $113.92 | 13 | 1 |
| Brewster, NE | $23.55 | $23.55 – $23.55 | 13 | 1 |
| New Orelans, LA | $30.57 | $30.57 – $30.57 | 13 | 1 |
| Yakutat, AK | $442.39 | $442.39 – $442.39 | 13 | 1 |
| Wallace, ID | $106.15 | $106.15 – $106.15 | 13 | 1 |
| Coolumbus, NE | $31.66 | $31.66 – $31.66 | 13 | 1 |
| Stoneboro, PA | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Milltown, NJ | $0.00 | $0.00 – $0.00 | 13 | 1 |
| Mt View, MO | $29.72 | $29.72 – $29.72 | 13 | 1 |
| Avoca, PA | $41.86 | $41.86 – $41.86 | 13 | 1 |
| Plymouth, PA | $9.64 | $9.64 – $9.64 | 14 | 1 |
| Churchville, NY | $63.52 | $63.52 – $63.52 | 14 | 1 |
| Ekron, KY | $36.91 | $36.91 – $36.91 | 14 | 1 |
| Coons Rapid, MN | $81.36 | $81.36 – $81.36 | 14 | 1 |
| Famington Hills, MI | $10.43 | $10.43 – $10.43 | 14 | 1 |
| Forestville, CA | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Stanley, ID | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Boggstown, IN | $66.70 | $66.70 – $66.70 | 14 | 1 |
| Colony, KS | $152.42 | $152.42 – $152.42 | 14 | 1 |
| Danielsville, PA | $38.72 | $38.72 – $38.72 | 14 | 1 |
| Rotterdam, NY | $50.29 | $50.29 – $50.29 | 14 | 1 |
| Perryville, AK | $379.19 | $379.19 – $379.19 | 14 | 1 |
| Elida, OH | $10.96 | $10.96 – $10.96 | 14 | 1 |
| Jenkinsville, SC | $177.50 | $177.50 – $177.50 | 14 | 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.