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 |
|---|---|---|---|---|
| Peterson Space Force Base, CO | $87.60 | $87.60 – $87.60 | 308 | 1 |
| Alcester, SD | $134.15 | $134.15 – $134.15 | 309 | 1 |
| Utica, OH | $39.86 | $39.86 – $39.86 | 309 | 1 |
| Bridgeport, PA | $52.31 | $52.31 – $52.31 | 309 | 1 |
| Pronceton, MO | $62.00 | $62.00 – $62.00 | 309 | 1 |
| Dexter, OR | $91.29 | $46.18 – $278.51 | 309 | 2 |
| Trempealeau, WI | $14.68 | $14.68 – $14.68 | 309 | 1 |
| Swan Point, MD | $116.77 | $116.77 – $116.77 | 309 | 1 |
| Centerville, AL | $0.00 | $0.00 – $0.00 | 309 | 1 |
| Scootsdale, AZ | $53.57 | $53.57 – $53.57 | 309 | 1 |
| Arnegard, ND | $63.39 | $63.39 – $63.39 | 309 | 1 |
| Mammoth Cave, KY | $52.32 | $52.32 – $52.32 | 310 | 1 |
| Marfa, TX | $43.84 | $27.56 – $54.69 | 310 | 2 |
| Mc Dermott, OH | $29.62 | $29.62 – $29.62 | 310 | 1 |
| Monrovia, MD | $116.58 | $116.58 – $116.58 | 310 | 1 |
| Adair, IA | $0.00 | $0.00 – $0.00 | 310 | 1 |
| Mountain View, HI | $60.31 | $38.10 – $74.37 | 312 | 2 |
| Marlow Heights, MD | $106.33 | $106.33 – $106.33 | 312 | 1 |
| Parkland, WA | $74.88 | $74.88 – $74.88 | 312 | 1 |
| West Sunbury, PA | $50.21 | $50.21 – $50.21 | 312 | 1 |
| Summerhill, PA | $39.77 | $39.77 – $39.77 | 312 | 1 |
| Greenwood, FL | $26.91 | $26.91 – $26.91 | 312 | 1 |
| Frazeysburg, OH | $32.63 | $32.63 – $32.63 | 312 | 1 |
| Vaiden, MS | $27.49 | $27.49 – $27.49 | 313 | 1 |
| Chappell Hill, TX | $37.95 | $37.95 – $37.95 | 313 | 1 |
| Juno Beach, FL | $13.84 | $4.25 – $36.88 | 313 | 2 |
| Erie, MI | $60.31 | $60.31 – $60.31 | 313 | 1 |
| Ridgely, MD | $201.10 | $201.10 – $201.10 | 313 | 1 |
| Shorewood, MN | $77.42 | $77.42 – $77.42 | 314 | 1 |
| Albany, WI | $30.38 | $30.38 – $30.38 | 314 | 1 |
| Rehrersburg, PA | $50.96 | $50.96 – $50.96 | 314 | 1 |
| Urbana, MD | $41.79 | $26.49 – $64.93 | 314 | 2 |
| Empire, CA | $2.66 | $0.00 – $2.78 | 315 | 2 |
| Dillsboro, NC | $269.86 | $269.86 – $269.86 | 315 | 1 |
| Normandy Park, WA | $64.21 | $0.00 – $80.19 | 315 | 3 |
| Edwards, MS | $15.98 | $15.98 – $15.98 | 316 | 1 |
| Sharpsville, PA | $52.71 | $52.71 – $52.71 | 316 | 1 |
| Kirbyville, TX | $11.71 | $10.17 – $14.18 | 317 | 2 |
| North Field, NJ | $11.70 | $11.70 – $11.70 | 317 | 1 |
| Bel Camp, MD | $113.71 | $113.71 – $113.71 | 317 | 1 |
| Miami, AZ | $43.51 | $43.51 – $43.51 | 317 | 1 |
| Glencoe, IL | $237.08 | $43.48 – $313.83 | 317 | 2 |
| New Plymouth, ID | $2.31 | $2.31 – $2.31 | 318 | 1 |
| Palisade, CO | $62.70 | $62.70 – $62.70 | 318 | 1 |
| Hockley, TX | $22.64 | $22.64 – $22.64 | 319 | 1 |
| Hollins, VA | $56.05 | $55.88 – $57.87 | 319 | 2 |
| Brocton, NY | $48.94 | $48.94 – $48.94 | 319 | 1 |
| Ballentine, SC | $36.59 | $13.70 – $48.80 | 319 | 3 |
| Warmisnter, PA | $47.49 | $47.49 – $47.49 | 320 | 1 |
| Inlet Beach, FL | $14.49 | $14.41 – $15.78 | 320 | 2 |
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.