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 |
|---|---|---|---|---|
| Arctic Village, AK | $471.07 | $471.07 – $471.07 | 14 | 1 |
| Sandy Spring, MD | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Atl, GA | $17.13 | $17.13 – $17.13 | 14 | 1 |
| Hometown, PA | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Winifred, MT | $93.26 | $93.26 – $93.26 | 14 | 1 |
| Allakaket, AK | $442.39 | $442.39 – $442.39 | 14 | 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 |
| Forestville, CA | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Coons Rapid, MN | $81.36 | $81.36 – $81.36 | 14 | 1 |
| Famington Hills, MI | $10.43 | $10.43 – $10.43 | 14 | 1 |
| Stanley, ID | $0.00 | $0.00 – $0.00 | 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 |
| 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 |
| Jenkinsville, SC | $177.50 | $177.50 – $177.50 | 14 | 1 |
| Mc Henry, MS | $34.45 | $34.45 – $34.45 | 14 | 1 |
| Crawley, WV | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Clarendon Hills, IL | $92.30 | $92.30 – $92.30 | 14 | 1 |
| North Weymouth, MA | $48.12 | $48.12 – $48.12 | 14 | 1 |
| Angwin, CA | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Brevig, AK | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Fonda, IA | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Carthage, IN | $56.84 | $56.84 – $56.84 | 14 | 1 |
| Pablo, MT | $41.88 | $41.88 – $41.88 | 14 | 1 |
| Grace, ID | $54.49 | $54.49 – $54.49 | 14 | 1 |
| N.Richland Hills, TX | $0.00 | $0.00 – $0.00 | 14 | 1 |
| Pennsylvania, PA | $64.82 | $64.82 – $64.82 | 15 | 1 |
| Teague, TX | $0.00 | $0.00 – $0.00 | 15 | 1 |
| Strawberry Plains, TN | $11.19 | $11.19 – $11.19 | 15 | 1 |
| Kaltag, AK | $412.90 | $412.90 – $412.90 | 15 | 1 |
| Brookshire, TX | $43.79 | $43.79 – $43.79 | 15 | 1 |
| New Pt Richey, FL | $15.01 | $15.01 – $15.01 | 15 | 1 |
| Bay Harbor, MI | $90.60 | $90.60 – $90.60 | 15 | 1 |
| Tripp, SD | $101.86 | $101.86 – $101.86 | 15 | 1 |
| Williamsfield, IL | $0.00 | $0.00 – $0.00 | 15 | 1 |
| Garden City, SC | $54.26 | $54.26 – $54.26 | 15 | 1 |
| Mt. Olivet, KY | $37.63 | $37.63 – $37.63 | 15 | 1 |
| Attica, KS | $214.37 | $214.37 – $214.37 | 15 | 1 |
| S Yarmouth, MA | $49.77 | $49.77 – $49.77 | 15 | 1 |
| Arendtsville, PA | $30.33 | $30.33 – $30.33 | 15 | 1 |
| Williamsburg, PA | $31.13 | $31.13 – $31.13 | 15 | 1 |
| Marathon, WI | $26.62 | $26.62 – $26.62 | 15 | 1 |
| Port Carbon, PA | $25.40 | $25.40 – $25.40 | 15 | 1 |
| Shoub Oak, NY | $148.45 | $148.45 – $148.45 | 15 | 1 |
| Mount Ephraim, NJ | $28.22 | $28.22 – $28.22 | 15 | 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.