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 |
|---|---|---|---|---|
| Northeast Harbor, ME | $31.07 | $31.07 – $31.07 | 523 | 1 |
| Munhall, PA | $49.75 | $34.73 – $52.38 | 524 | 3 |
| Zelienople, PA | $48.44 | $48.44 – $48.44 | 526 | 1 |
| Jackson, NC | $1.45 | $0.00 – $5.26 | 527 | 5 |
| Manchester, NJ | $10.60 | $10.60 – $10.60 | 528 | 1 |
| Hamilton Township, NJ | $35.02 | $3.69 – $47.24 | 528 | 3 |
| Mansfield, AR | $40.93 | $17.81 – $43.95 | 528 | 2 |
| Naubinway, MI | $59.83 | $59.83 – $59.83 | 529 | 1 |
| Red Bank, TN | $71.24 | $50.17 – $71.73 | 530 | 2 |
| Mt. Eaton, OH | $15.01 | $15.01 – $15.01 | 531 | 1 |
| Shermans Dale, PA | $40.59 | $34.06 – $45.35 | 531 | 2 |
| Hinkle, KY | $33.39 | $33.39 – $33.39 | 532 | 1 |
| Denmark, TN | $40.90 | $40.90 – $40.90 | 532 | 1 |
| Riley, KS | $175.70 | $175.70 – $175.70 | 533 | 1 |
| Swoyersville, PA | $14.08 | $14.08 – $14.08 | 533 | 1 |
| Shelbyville, MO | $19.33 | $19.33 – $19.33 | 533 | 1 |
| Aurora, OR | $208.73 | $208.73 – $208.73 | 534 | 1 |
| Third Lake, IL | $22.80 | $22.80 – $22.80 | 534 | 1 |
| Colfax, WI | $42.28 | $42.28 – $42.28 | 535 | 1 |
| Thornton, WV | $75.35 | $75.35 – $75.35 | 536 | 1 |
| Ocean Pines, MD | $70.28 | $11.40 – $71.86 | 537 | 2 |
| Califon, NJ | $80.51 | $74.55 – $83.67 | 538 | 4 |
| Leachville, AR | $20.11 | $20.11 – $20.11 | 538 | 1 |
| Walnut Grove, AL | $2.97 | $2.97 – $2.97 | 538 | 1 |
| Roosevelt Island, NY | $64.89 | $31.44 – $65.72 | 538 | 2 |
| Nocona, TX | $29.99 | $16.11 – $48.69 | 538 | 3 |
| Sultland, MD | $88.13 | $88.13 – $88.13 | 538 | 1 |
| Ethel, LA | $5.37 | $5.37 – $5.37 | 538 | 1 |
| Running Springs, CA | $48.39 | $48.39 – $48.39 | 539 | 1 |
| Owing Mills, MD | $132.15 | $132.15 – $132.15 | 539 | 1 |
| Incline Village, NV | $31.11 | $30.76 – $31.44 | 540 | 2 |
| Apo, NY | $61.03 | $57.09 – $102.39 | 540 | 2 |
| Tornball, TX | $32.82 | $32.82 – $32.82 | 540 | 1 |
| Angel Fire, NM | $63.50 | $63.50 – $63.50 | 540 | 1 |
| Lagrange, ME | $43.16 | $43.16 – $43.16 | 541 | 1 |
| Clio, SC | $39.40 | $39.40 – $39.40 | 541 | 1 |
| Fairchild Air Force Base, WA | $38.12 | $38.12 – $38.12 | 543 | 1 |
| St John, ND | $539.34 | $539.34 – $539.34 | 543 | 1 |
| Astoria, IL | $0.09 | $0.09 – $0.09 | 544 | 1 |
| Atlantic Beach, FL | $86.84 | $86.84 – $86.84 | 544 | 1 |
| Kailuakona, HI | $32.83 | $32.83 – $32.83 | 544 | 1 |
| Fairway, KS | $27.99 | $27.99 – $27.99 | 545 | 1 |
| Emerson, NE | $128.14 | $128.14 – $128.14 | 546 | 1 |
| Hewitt, TX | $45.73 | $4.53 – $52.63 | 546 | 4 |
| Constantine, MI | $42.41 | $42.41 – $42.41 | 547 | 1 |
| Ft. Oglethorpe, GA | $14.98 | $14.98 – $14.98 | 548 | 1 |
| Alfred, NY | $70.82 | $70.82 – $70.82 | 548 | 1 |
| Shady Spring, WV | $35.82 | $21.26 – $38.56 | 549 | 2 |
| Cross Plains, WI | $28.08 | $12.89 – $40.41 | 549 | 6 |
| Burnsville, MS | $42.39 | $11.23 – $54.56 | 549 | 4 |
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.