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 |
|---|---|---|---|---|
| Tipton, MI | $47.44 | $47.44 – $47.44 | 573 | 1 |
| Fort Lewis, WA | $41.12 | $41.12 – $41.12 | 575 | 1 |
| Laverne, OK | $133.24 | $133.24 – $133.24 | 575 | 1 |
| Windsor, WI | $26.35 | $17.73 – $50.83 | 576 | 3 |
| Christiansted, St. Croix, VI | $29.36 | $29.36 – $29.36 | 577 | 1 |
| Dekalb Junction, NY | $58.40 | $47.68 – $63.55 | 577 | 2 |
| Saint Charles, IA | $12.80 | $12.80 – $12.80 | 577 | 1 |
| Verdigre, NE | $32.27 | $31.17 – $80.28 | 577 | 2 |
| Oakbrook, IL | $53.49 | $53.49 – $53.49 | 577 | 1 |
| Centerville, MN | $17.24 | $11.87 – $65.38 | 578 | 2 |
| Williamsville, IL | $38.39 | $38.39 – $38.39 | 578 | 1 |
| Red Lake Falls, MN | $241.12 | $241.12 – $241.12 | 578 | 1 |
| Whitmire, SC | $47.89 | $47.89 – $47.89 | 580 | 1 |
| Dillionvale, OH | $37.90 | $37.90 – $37.90 | 581 | 1 |
| Santa, ID | $32.33 | $32.33 – $32.33 | 581 | 1 |
| Falkner, MS | $42.09 | $42.09 – $42.09 | 582 | 1 |
| Mapleton, ND | $58.05 | $58.05 – $58.05 | 583 | 1 |
| Alex City, AL | $28.56 | $24.30 – $53.07 | 583 | 3 |
| Mifflin, PA | $34.66 | $34.66 – $34.66 | 583 | 1 |
| Brundidge, AL | $22.76 | $22.76 – $22.76 | 585 | 1 |
| Black Creek, WI | $36.18 | $32.40 – $49.80 | 585 | 2 |
| Kendall, NY | $57.67 | $57.67 – $57.67 | 585 | 1 |
| West, TX | $37.38 | $33.15 – $37.84 | 585 | 2 |
| New Sharon, IA | $31.76 | $31.76 – $31.76 | 586 | 1 |
| Silver Springs, FL | $169.33 | $169.33 – $169.33 | 586 | 1 |
| Dahlgren, VA | $32.52 | $32.52 – $32.52 | 586 | 1 |
| Granite, OK | $80.99 | $80.99 – $80.99 | 587 | 1 |
| Ravenwood, WV | $59.61 | $59.61 – $59.61 | 588 | 1 |
| Naknek, AK | $350.93 | $108.82 – $712.34 | 588 | 3 |
| South Barrington, IL | $67.56 | $0.00 – $318.75 | 589 | 5 |
| North Little, AR | $37.40 | $37.40 – $37.40 | 589 | 1 |
| Gilmanton Iron Works, NH | $41.70 | $41.70 – $41.70 | 590 | 1 |
| Roxana, IL | $4.74 | $4.74 – $4.74 | 591 | 1 |
| Bowling Green, SC | $68.80 | $68.80 – $68.80 | 592 | 1 |
| Wake Village, TX | $41.56 | $10.09 – $70.54 | 592 | 3 |
| Goldthwaite, TX | $10.91 | $8.62 – $53.86 | 592 | 2 |
| Brady, TX | $15.61 | $11.51 – $15.75 | 593 | 2 |
| El Monte, AL | $0.00 | $0.00 – $0.00 | 594 | 1 |
| Calhoun Falls, SC | $168.48 | $168.48 – $168.48 | 594 | 1 |
| Velva, ND | $77.28 | $76.09 – $77.66 | 594 | 2 |
| Duchesne, UT | $95.79 | $95.79 – $95.79 | 595 | 1 |
| Perth, NY | $68.96 | $56.34 – $91.75 | 595 | 2 |
| Beatty, NV | $157.41 | $157.41 – $157.41 | 595 | 1 |
| Smithville, TX | $2.72 | $2.72 – $2.72 | 597 | 1 |
| Beaver Falls, NY | $66.21 | $65.70 – $67.83 | 597 | 2 |
| Montevallo, AL | $40.42 | $0.00 – $76.82 | 598 | 4 |
| Fort Washingtion, MD | $27.91 | $27.91 – $27.91 | 598 | 1 |
| West Liberty, WV | $25.13 | $25.13 – $25.13 | 599 | 1 |
| So Portland, ME | $45.10 | $45.10 – $45.10 | 600 | 1 |
| Clio, AL | $45.20 | $45.20 – $45.20 | 600 | 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.