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 |
|---|---|---|---|---|
| Schenectody, NY | $50.74 | $50.74 – $50.74 | 172 | 1 |
| Kadoka, SD | $70.49 | $70.49 – $70.49 | 172 | 1 |
| Shonto, AZ | $26.18 | $18.16 – $33.48 | 172 | 2 |
| Lake Oswergo, OR | $44.39 | $44.39 – $44.39 | 172 | 1 |
| Mount Victory, OH | $37.52 | $36.92 – $44.81 | 172 | 2 |
| Gladbrook, IA | $28.47 | $25.28 – $57.69 | 173 | 2 |
| Hanahan, SC | $33.82 | $33.82 – $33.82 | 173 | 1 |
| Conneaut Lake, PA | $0.00 | $0.00 – $0.00 | 173 | 1 |
| Schereville, IN | $36.91 | $36.91 – $36.91 | 174 | 1 |
| Groton, SD | $31.34 | $31.34 – $31.34 | 175 | 1 |
| Cross Plains, TX | $43.86 | $39.24 – $48.79 | 175 | 4 |
| Lewisville, AR | $10.10 | $8.47 – $18.32 | 175 | 2 |
| East Syaruse, NY | $93.06 | $93.06 – $93.06 | 175 | 1 |
| Gordonville, PA | $48.74 | $48.74 – $48.74 | 176 | 1 |
| Slidel, LA | $39.32 | $39.32 – $39.32 | 176 | 1 |
| Deshler, OH | $42.55 | $42.55 – $42.55 | 176 | 1 |
| Farmington, Mo, MO | $25.90 | $25.90 – $25.90 | 176 | 1 |
| Penn Valley, PA | $15.29 | $0.00 – $65.27 | 176 | 6 |
| Altoona, FL | $21.06 | $21.06 – $21.06 | 177 | 1 |
| Lindsay, NE | $39.91 | $39.91 – $39.91 | 177 | 1 |
| Leetsdale, PA | $56.62 | $27.52 – $72.28 | 177 | 3 |
| Lemars, IA | $0.00 | $0.00 – $0.00 | 177 | 1 |
| Garfiled Heights, OH | $22.38 | $22.38 – $22.38 | 179 | 1 |
| Glasco, KS | $118.38 | $118.38 – $118.38 | 179 | 1 |
| Eliot, ME | $43.38 | $43.38 – $43.38 | 179 | 1 |
| E Mc Keesport, PA | $22.51 | $22.51 – $22.51 | 179 | 1 |
| Darnestown, MD | $95.11 | $95.11 – $95.11 | 179 | 1 |
| De Leon, TX | $0.00 | $0.00 – $0.00 | 179 | 1 |
| Rector, AR | $40.17 | $1.86 – $84.11 | 180 | 3 |
| Port Graham, AK | $239.27 | $217.96 – $313.86 | 180 | 2 |
| Fort Cavasos, TX | $33.14 | $33.14 – $33.14 | 181 | 1 |
| Palm Shores, FL | $79.78 | $79.78 – $79.78 | 181 | 1 |
| Spanishburg, WV | $57.07 | $57.07 – $57.07 | 182 | 1 |
| Eads, CO | $84.36 | $47.06 – $152.06 | 182 | 5 |
| Pineland, TX | $31.96 | $31.96 – $31.96 | 182 | 1 |
| Esparto, CA | $2.55 | $2.55 – $2.55 | 183 | 1 |
| Louin, MS | $19.43 | $19.43 – $19.43 | 183 | 1 |
| Sunset Beach, CA | $6.65 | $6.65 – $6.65 | 183 | 1 |
| Wassaic, NY | $95.02 | $93.89 – $111.21 | 183 | 2 |
| Pojoaque, NM | $48.91 | $48.91 – $48.91 | 183 | 1 |
| Keene, NY | $38.03 | $38.03 – $38.03 | 184 | 1 |
| Jay, VT | $0.00 | $0.00 – $0.00 | 184 | 1 |
| Belle Center, OH | $137.56 | $137.56 – $137.56 | 184 | 1 |
| Port Jeff Sta, NY | $36.39 | $36.39 – $36.39 | 184 | 1 |
| Croswell, MI | $51.18 | $51.18 – $51.18 | 185 | 1 |
| Mineapolis, MN | $64.96 | $64.96 – $64.96 | 185 | 1 |
| Woodbourne, NY | $76.03 | $76.03 – $76.03 | 185 | 1 |
| Cula Vista, CA | $3.95 | $3.95 – $3.95 | 185 | 1 |
| Mt. Laurel, NJ | $137.74 | $54.25 – $170.13 | 186 | 2 |
| Strathmore, CA | $20.23 | $20.23 – $20.23 | 186 | 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.