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 |
|---|---|---|---|---|
| Mount Ephraim, NJ | $28.22 | $28.22 – $28.22 | 15 | 1 |
| Herscher, IL | $39.56 | $39.56 – $39.56 | 15 | 1 |
| Spearman, TX | $54.29 | $54.29 – $54.29 | 15 | 1 |
| Benton, WI | $5.15 | $5.15 – $5.15 | 15 | 1 |
| Bellevue, TN | $31.96 | $31.96 – $31.96 | 15 | 1 |
| Norris, TN | $42.86 | $42.86 – $42.86 | 15 | 1 |
| Mcmurray, PA | $22.60 | $22.60 – $22.60 | 15 | 1 |
| Georgetown, ID | $152.25 | $152.25 – $152.25 | 15 | 1 |
| Fowler, OH | $22.19 | $22.19 – $22.19 | 15 | 1 |
| Alief, TX | $42.36 | $42.36 – $42.36 | 15 | 1 |
| Drummond, MT | $0.00 | $0.00 – $0.00 | 15 | 1 |
| Eckerman, MI | $54.27 | $54.27 – $54.27 | 15 | 1 |
| Adams, NE | $129.00 | $129.00 – $129.00 | 15 | 1 |
| Fayetteville, OH | $45.05 | $45.05 – $45.05 | 15 | 1 |
| Amherst, WI | $40.61 | $40.61 – $40.61 | 15 | 1 |
| Colorado Spings, CO | $227.49 | $227.49 – $227.49 | 16 | 1 |
| Joaquin, TX | $0.00 | $0.00 – $0.00 | 16 | 1 |
| Dally City, CA | $29.80 | $29.80 – $29.80 | 16 | 1 |
| Marine City, MI | $72.33 | $72.33 – $72.33 | 16 | 1 |
| Bellevue, ID | $0.00 | $0.00 – $0.00 | 16 | 1 |
| Wilson, OK | $2.15 | $2.15 – $2.15 | 16 | 1 |
| Carmel, ME | $67.30 | $67.30 – $67.30 | 16 | 1 |
| Shiocton, WI | $16.76 | $16.76 – $16.76 | 16 | 1 |
| No Branch, MN | $24.97 | $24.97 – $24.97 | 16 | 1 |
| Grand Chute, WI | $79.49 | $79.49 – $79.49 | 16 | 1 |
| Mentasta Lake, AK | $313.57 | $313.57 – $313.57 | 16 | 1 |
| Cecilia, LA | $17.62 | $17.62 – $17.62 | 16 | 1 |
| Brooklyn, NJ | $63.78 | $63.78 – $63.78 | 16 | 1 |
| East Syracuse, NM | $63.89 | $63.89 – $63.89 | 16 | 1 |
| Glen Fork, WV | $77.19 | $77.19 – $77.19 | 16 | 1 |
| Victoria, MN | $1.23 | $1.23 – $1.23 | 16 | 1 |
| Evans, WV | $47.37 | $47.37 – $47.37 | 16 | 1 |
| Millvale, PA | $24.06 | $24.06 – $24.06 | 16 | 1 |
| Milburn, OK | $80.11 | $80.11 – $80.11 | 16 | 1 |
| Pitsburgh, PA | $25.45 | $25.45 – $25.45 | 16 | 1 |
| Quaker Hill, CT | $18.11 | $18.11 – $18.11 | 16 | 1 |
| Platinum, AK | $427.59 | $427.59 – $427.59 | 16 | 1 |
| Bedford Park, IL | $36.32 | $36.32 – $36.32 | 16 | 1 |
| Elk Garden, WV | $51.14 | $51.14 – $51.14 | 16 | 1 |
| Zumbro Falls, MN | $40.93 | $40.93 – $40.93 | 16 | 1 |
| West Shokan, NY | $52.71 | $52.71 – $52.71 | 16 | 1 |
| Arrecibo, PR | $138.21 | $138.21 – $138.21 | 16 | 1 |
| Heber, UT | $61.14 | $61.14 – $61.14 | 16 | 1 |
| Bethlehem, NH | $79.92 | $79.92 – $79.92 | 16 | 1 |
| Lovell, ME | $25.94 | $25.94 – $25.94 | 16 | 1 |
| Plains Twp, PA | $0.00 | $0.00 – $0.00 | 17 | 1 |
| Mt. Vernon, MO | $102.20 | $102.20 – $102.20 | 17 | 1 |
| Black Rock, AR | $24.01 | $24.01 – $24.01 | 17 | 1 |
| Laporte, PA | $27.18 | $27.18 – $27.18 | 17 | 1 |
| Hemingford, NE | $76.55 | $76.55 – $76.55 | 17 | 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.