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 |
|---|---|---|---|---|
| Blue Hill, NE | $71.72 | $44.59 – $132.00 | 449 | 3 |
| Newton Lower Falls, MA | $52.99 | $52.99 – $52.99 | 449 | 1 |
| Wainscott, NY | $109.73 | $60.13 – $132.20 | 449 | 4 |
| Oakland Township, MI | $81.28 | $81.28 – $81.28 | 450 | 1 |
| Hardy, AR | $43.91 | $22.04 – $50.81 | 450 | 3 |
| Linn, MO | $38.73 | $18.03 – $46.49 | 451 | 2 |
| Middleburgh, NY | $46.32 | $38.65 – $70.15 | 451 | 3 |
| Hollywood, SC | $14.87 | $14.35 – $33.80 | 451 | 2 |
| South St Paul, MN | $64.24 | $64.24 – $64.24 | 452 | 1 |
| Avila Beach, CA | $47.94 | $47.69 – $55.78 | 452 | 2 |
| Tamms, IL | $0.00 | $0.00 – $0.00 | 453 | 1 |
| Poland, IN | $6.70 | $6.70 – $6.70 | 453 | 1 |
| Kapaia, HI | $205.86 | $205.86 – $205.86 | 454 | 1 |
| Winchester, KS | $30.50 | $27.03 – $37.73 | 454 | 3 |
| Ravenna, NE | $160.81 | $35.37 – $248.49 | 455 | 3 |
| Fuquary Varina, NC | $49.62 | $49.62 – $49.62 | 456 | 1 |
| Jamesport, MO | $46.02 | $39.71 – $62.16 | 457 | 3 |
| East Berne, NY | $61.62 | $61.62 – $61.62 | 457 | 1 |
| Bededo, GU | $55.34 | $55.34 – $55.34 | 458 | 1 |
| Walhalla, ND | $146.91 | $146.91 – $146.91 | 459 | 1 |
| Eden, TX | $50.66 | $0.00 – $52.02 | 459 | 2 |
| Waverly, MO | $78.72 | $78.44 – $87.02 | 460 | 2 |
| Fort Harrison, MT | $61.34 | $60.55 – $62.21 | 460 | 2 |
| Dexter, KS | $144.52 | $144.52 – $144.52 | 460 | 1 |
| Glen Rogers, WV | $0.00 | $0.00 – $0.00 | 461 | 1 |
| Pine Hill, NM | $23.15 | $16.78 – $25.75 | 462 | 2 |
| Maple Hill, NC | $64.26 | $2.60 – $69.00 | 462 | 2 |
| S Glastonbury, CT | $95.13 | $95.13 – $95.13 | 462 | 1 |
| Oktaha, OK | $73.53 | $73.53 – $73.53 | 464 | 1 |
| Blanco, TX | $421.69 | $421.69 – $421.69 | 465 | 1 |
| Caliente, NV | $38.18 | $0.00 – $60.80 | 465 | 2 |
| Spring Lake, NJ | $37.04 | $0.00 – $38.71 | 465 | 2 |
| Airway Heights, WA | $54.47 | $54.47 – $54.47 | 466 | 1 |
| Odebolt, IA | $0.46 | $0.46 – $0.46 | 468 | 1 |
| St Anthony Village, MN | $178.11 | $178.11 – $178.11 | 468 | 1 |
| Johannesburg, MI | $14.94 | $14.94 – $14.94 | 469 | 1 |
| Nokesville, VA | $51.43 | $41.03 – $69.38 | 469 | 4 |
| Wonder Lake, IL | $59.26 | $59.26 – $59.26 | 470 | 1 |
| Port Aransas, TX | $70.40 | $70.40 – $70.40 | 470 | 1 |
| Fowlerville, MI | $70.25 | $70.25 – $70.25 | 471 | 1 |
| Stone Harbor, NJ | $62.60 | $62.50 – $66.75 | 471 | 2 |
| Iowa Park, TX | $39.08 | $21.23 – $43.76 | 471 | 3 |
| Mckessport, PA | $65.68 | $65.68 – $65.68 | 472 | 1 |
| Moro, OR | $53.25 | $50.67 – $54.58 | 473 | 2 |
| Washburn, ND | $85.81 | $82.43 – $196.70 | 474 | 2 |
| Gibbstown, NJ | $59.52 | $59.52 – $59.52 | 474 | 1 |
| Redlake, MN | $545.73 | $545.73 – $545.73 | 475 | 1 |
| Hammond, OR | $71.60 | $71.60 – $71.60 | 475 | 1 |
| Ambler, AK | $111.22 | $87.53 – $399.58 | 475 | 3 |
| Stratford, CA | $2.39 | $0.00 – $2.49 | 475 | 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.