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 |
|---|---|---|---|---|
| Remington, VA | $67.38 | $67.38 – $67.38 | 475 | 1 |
| Esko, MN | $19.72 | $19.72 – $19.72 | 476 | 1 |
| St Joseph, MN | $81.86 | $74.64 – $93.88 | 477 | 3 |
| Neshanic Station, NJ | $51.00 | $49.46 – $51.31 | 478 | 2 |
| Coal Center, PA | $38.87 | $37.73 – $40.46 | 479 | 3 |
| 222-19 Linden Blvd, NY | $10.02 | $10.02 – $10.02 | 479 | 1 |
| Tekonsha, MI | $21.82 | $12.53 – $38.40 | 479 | 2 |
| Stanton, TX | $80.32 | $28.22 – $128.31 | 479 | 4 |
| Stratusburg, PA | $39.28 | $39.28 – $39.28 | 480 | 1 |
| Hallsville, MO | $64.81 | $64.41 – $64.82 | 480 | 2 |
| Rusk, TX | $42.41 | $38.52 – $75.91 | 481 | 2 |
| Wallis, TX | $8.19 | $8.19 – $8.19 | 481 | 1 |
| Sperryville, VA | $63.31 | $63.31 – $63.31 | 482 | 1 |
| Graham, WA | $54.89 | $54.89 – $54.89 | 482 | 1 |
| West Branch, IA | $18.46 | $12.42 – $24.44 | 482 | 2 |
| Happy, KY | $34.43 | $34.43 – $34.43 | 482 | 1 |
| Wurtsboro, NY | $103.63 | $103.63 – $103.63 | 483 | 1 |
| Blawnox, PA | $50.43 | $26.12 – $68.21 | 483 | 4 |
| Norlina, NC | $2.54 | $0.00 – $4.53 | 483 | 2 |
| Fort Gregg Adams, VA | $68.95 | $68.95 – $68.95 | 483 | 1 |
| Maybrook, NY | $74.16 | $74.16 – $74.16 | 484 | 1 |
| Fort Cavazos, TX | $13.72 | $3.62 – $83.32 | 484 | 5 |
| Brooklyn Heights, NY | $34.56 | $26.45 – $59.23 | 485 | 2 |
| Altamont, TN | $93.44 | $93.44 – $93.44 | 485 | 1 |
| Mount Rainier, MD | $65.57 | $48.22 – $66.59 | 485 | 2 |
| Fairplay, CO | $70.85 | $40.17 – $74.60 | 486 | 2 |
| Munfordfille, KY | $26.92 | $26.92 – $26.92 | 486 | 1 |
| Springdale, WA | $19.11 | $19.11 – $19.11 | 486 | 1 |
| Farmersville, IL | $45.11 | $45.11 – $45.11 | 487 | 1 |
| Berkley, MA | $58.86 | $58.86 – $58.86 | 488 | 1 |
| Dover, NC | $56.42 | $56.42 – $56.42 | 489 | 1 |
| Malmstrom Afb, MT | $93.92 | $62.22 – $139.75 | 490 | 5 |
| Long Pond, PA | $20.92 | $20.92 – $20.92 | 491 | 1 |
| Industry, PA | $33.60 | $33.60 – $33.60 | 491 | 1 |
| Fort Nill, SC | $62.11 | $62.11 – $62.11 | 492 | 1 |
| Clymer, PA | $40.70 | $30.85 – $57.15 | 492 | 3 |
| Canaan, NY | $190.77 | $190.77 – $190.77 | 493 | 1 |
| Crosby, ND | $101.22 | $49.81 – $139.38 | 493 | 3 |
| Pacific Grove, CA | $85.20 | $85.20 – $85.20 | 495 | 1 |
| Prichard, AL | $0.00 | $0.00 – $0.00 | 496 | 1 |
| Ft Sam Houston, TX | $28.67 | $28.67 – $28.67 | 497 | 1 |
| Red Oak, OK | $50.32 | $50.32 – $50.32 | 497 | 1 |
| South Barre, VT | $13.95 | $13.95 – $13.95 | 498 | 1 |
| Mize, MS | $223.03 | $223.03 – $223.03 | 499 | 1 |
| Cable, WI | $43.76 | $43.76 – $43.76 | 500 | 1 |
| West Fork, AR | $43.70 | $43.70 – $43.70 | 500 | 1 |
| Wlks Barr Twp, PA | $49.39 | $49.39 – $49.39 | 501 | 1 |
| Highland, KS | $131.05 | $131.05 – $131.05 | 501 | 1 |
| Jordan, AR | $34.41 | $34.41 – $34.41 | 502 | 1 |
| Farmington, NH | $13.60 | $12.40 – $58.68 | 502 | 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.