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 |
|---|---|---|---|---|
| Lafayette, NJ | $43.83 | $34.32 – $46.02 | 427 | 2 |
| Jb Pearl Harbor Hickam, HI | $226.01 | $226.01 – $226.01 | 428 | 1 |
| Bethlhem, PA | $46.88 | $46.88 – $46.88 | 428 | 1 |
| View Park, CA | $41.47 | $41.47 – $41.47 | 428 | 1 |
| Lake Mills, IA | $45.60 | $45.60 – $45.60 | 428 | 1 |
| Whitakers, NC | $3.04 | $0.00 – $11.07 | 429 | 3 |
| Prairie Grove, AR | $21.73 | $14.40 – $31.76 | 429 | 3 |
| Mt Carmel, PA | $47.09 | $8.49 – $51.39 | 429 | 2 |
| Lake Wylie, SC | $71.54 | $71.54 – $71.54 | 430 | 1 |
| Little Chute, WI | $28.78 | $12.91 – $31.58 | 430 | 4 |
| Angola, NY | $70.71 | $70.71 – $70.71 | 430 | 1 |
| Siren, WI | $8.51 | $8.51 – $8.51 | 431 | 1 |
| Moreaville, LA | $0.80 | $0.80 – $0.80 | 431 | 1 |
| Elberta, AL | $67.85 | $62.99 – $81.18 | 431 | 3 |
| Ashville, NC | $54.59 | $52.73 – $77.04 | 431 | 2 |
| Schuylerville, NY | $60.07 | $60.07 – $60.07 | 432 | 1 |
| Cape Gerardeau, MO | $57.41 | $57.41 – $57.41 | 432 | 1 |
| Barneveld, WI | $29.03 | $25.79 – $30.06 | 432 | 2 |
| Long View, NC | $48.63 | $48.63 – $48.63 | 434 | 1 |
| Athol, ID | $64.79 | $56.36 – $77.10 | 435 | 3 |
| Inverness, MS | $11.20 | $11.20 – $11.20 | 435 | 1 |
| Hawley, MN | $41.37 | $41.16 – $42.03 | 436 | 2 |
| Shawnee-On-Delaware, PA | $48.94 | $48.94 – $48.94 | 438 | 1 |
| Edwards Afb, CA | $62.57 | $62.57 – $62.57 | 438 | 1 |
| Sloatsburg, NY | $53.41 | $53.41 – $53.41 | 438 | 1 |
| North Oaks, MN | $49.77 | $25.63 – $66.55 | 438 | 3 |
| Veguita, NM | $141.38 | $141.38 – $141.38 | 439 | 1 |
| Palmas Del Mar, Humacao, PR | $73.58 | $73.58 – $73.58 | 439 | 1 |
| Larchwood, IA | $32.52 | $32.52 – $32.52 | 440 | 1 |
| Teller, AK | $397.45 | $383.44 – $439.67 | 440 | 5 |
| Salisbury, CT | $43.77 | $0.00 – $50.58 | 440 | 4 |
| Sugar Hill, GA | $175.64 | $175.64 – $175.64 | 441 | 1 |
| Fulda, MN | $218.45 | $218.45 – $218.45 | 441 | 1 |
| Heflin, LA | $20.37 | $20.37 – $20.37 | 441 | 1 |
| Spencer, OH | $40.29 | $40.29 – $40.29 | 441 | 1 |
| Etna, CA | $0.11 | $0.00 – $1.55 | 441 | 2 |
| Ellsworth, WI | $26.21 | $8.77 – $56.68 | 442 | 3 |
| Brentwood, NH | $19.19 | $9.20 – $49.47 | 443 | 3 |
| Edgemont, AR | $20.76 | $20.76 – $20.76 | 443 | 1 |
| Mt Arlington, NJ | $96.33 | $31.94 – $98.90 | 443 | 2 |
| Orbisonia, PA | $10.17 | $1.74 – $32.86 | 443 | 2 |
| N Palm Beach, FL | $74.51 | $74.51 – $74.51 | 443 | 1 |
| Christiansbrg, VA | $58.15 | $58.15 – $58.15 | 444 | 1 |
| Crawford, NE | $94.17 | $94.17 – $94.17 | 444 | 1 |
| Valley Head, AL | $37.31 | $37.31 – $37.31 | 444 | 1 |
| Roscoe, NY | $91.27 | $91.27 – $91.27 | 445 | 1 |
| Thatcher, AZ | $26.59 | $12.46 – $54.98 | 447 | 3 |
| Caroga Lake, NY | $88.60 | $88.60 – $88.60 | 448 | 1 |
| Santo Domingo Pueblo, NM | $70.95 | $66.03 – $76.94 | 448 | 3 |
| Whomissing, PA | $37.99 | $37.99 – $37.99 | 448 | 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.