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 |
|---|---|---|---|---|
| Flushing, OH | $31.49 | $31.49 – $31.49 | 360 | 1 |
| Mount Calvary, WI | $20.87 | $20.87 – $20.87 | 361 | 1 |
| Wakefield, VA | $46.96 | $40.73 – $63.90 | 361 | 2 |
| Augusta, IL | $25.74 | $25.74 – $25.74 | 362 | 1 |
| Denmark, WI | $35.45 | $25.69 – $42.10 | 362 | 4 |
| Appalachia, VA | $30.36 | $29.68 – $48.64 | 362 | 2 |
| Danielsville, GA | $115.87 | $115.87 – $115.87 | 362 | 1 |
| Stamford, TX | $5.75 | $5.75 – $5.75 | 362 | 1 |
| Canyon Lake, TX | $36.36 | $36.36 – $36.36 | 362 | 1 |
| Deering, AK | $167.02 | $165.01 – $168.48 | 362 | 2 |
| Perry, OH | $75.45 | $24.55 – $79.54 | 363 | 2 |
| Brinklow, MD | $95.90 | $95.90 – $95.90 | 363 | 1 |
| Holyoke, CO | $76.95 | $4.32 – $197.98 | 363 | 5 |
| Garland, NC | $6.32 | $6.32 – $6.32 | 364 | 1 |
| Battle Lake, MN | $49.35 | $49.35 – $49.35 | 364 | 1 |
| St Matthews, KY | $30.78 | $30.78 – $30.78 | 364 | 1 |
| Sauget, IL | $5.05 | $0.00 – $34.16 | 365 | 2 |
| Mount Ida, AR | $29.88 | $29.88 – $29.88 | 365 | 1 |
| Springdale, MD | $122.31 | $0.00 – $130.10 | 367 | 2 |
| Willow Springs, IL | $83.95 | $83.95 – $83.95 | 367 | 1 |
| Wolcottville, IN | $46.84 | $46.84 – $46.84 | 367 | 1 |
| French Creek, WV | $41.97 | $41.97 – $41.97 | 368 | 1 |
| Gulfport, FL | $34.15 | $34.15 – $34.15 | 368 | 1 |
| Highland Mills, NY | $109.47 | $109.33 – $113.55 | 369 | 2 |
| Upperglade, WV | $0.00 | $0.00 – $0.00 | 370 | 1 |
| North Collins, NY | $79.13 | $60.23 – $131.30 | 370 | 3 |
| Sanostee, NM | $287.45 | $287.45 – $287.45 | 371 | 1 |
| St. Loius, MO | $104.74 | $104.74 – $104.74 | 371 | 1 |
| Little Falls, NJ | $15.78 | $15.66 – $19.52 | 371 | 2 |
| Drummond Island, MI | $48.43 | $45.74 – $49.03 | 372 | 2 |
| Dresden, OH | $41.59 | $34.31 – $42.49 | 372 | 2 |
| Adrian, MO | $78.88 | $39.34 – $80.31 | 372 | 2 |
| Seaville, NJ | $54.14 | $54.14 – $54.14 | 374 | 1 |
| Port Neches, TX | $34.24 | $30.49 – $138.46 | 374 | 2 |
| Elizabeth, CO | $50.90 | $50.90 – $50.90 | 375 | 1 |
| Lawrence Township, NJ | $58.05 | $1.18 – $72.98 | 375 | 5 |
| Salisbury, VT | $64.24 | $64.24 – $64.24 | 376 | 1 |
| Scott City, MO | $48.85 | $37.16 – $49.40 | 376 | 2 |
| Woodford, VA | $75.77 | $75.77 – $75.77 | 377 | 1 |
| Atkinson, NC | $53.08 | $53.08 – $53.08 | 377 | 1 |
| Manvel, TX | $18.43 | $0.99 – $27.67 | 378 | 2 |
| Colt, AR | $45.73 | $45.73 – $45.73 | 379 | 1 |
| Colver, PA | $35.80 | $35.80 – $35.80 | 380 | 1 |
| Fancy Gap, VA | $19.56 | $13.86 – $24.59 | 380 | 2 |
| Honomu, HI | $83.76 | $83.76 – $83.76 | 380 | 1 |
| Leroy, NY | $88.42 | $88.42 – $88.42 | 381 | 1 |
| Lead, SD | $68.56 | $68.56 – $68.56 | 381 | 1 |
| Shprock, NM | $562.60 | $562.60 – $562.60 | 381 | 1 |
| Fordyce, AR | $33.69 | $22.01 – $41.18 | 381 | 2 |
| Maud, TX | $8.87 | $8.87 – $8.87 | 381 | 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.