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 |
|---|---|---|---|---|
| Lansing, IA | $2.51 | $2.51 – $2.51 | 677 | 1 |
| Ethete, WY | $0.95 | $0.95 – $0.95 | 677 | 1 |
| Mountain View, WY | $2.18 | $2.18 – $2.18 | 678 | 1 |
| Big Falls, MN | $192.24 | $192.24 – $192.24 | 678 | 1 |
| Pleasant Hills, PA | $46.81 | $22.88 – $55.69 | 679 | 3 |
| Easton, CT | $85.31 | $85.31 – $85.31 | 681 | 1 |
| Evansville, WI | $39.76 | $38.38 – $41.94 | 681 | 2 |
| Douglasville, PA | $47.59 | $47.59 – $47.59 | 682 | 1 |
| Apple Grove, WV | $55.85 | $0.00 – $65.10 | 683 | 3 |
| Troy, VA | $44.73 | $44.73 – $44.73 | 683 | 1 |
| Brackenridge, PA | $39.35 | $36.41 – $40.93 | 687 | 2 |
| Wentworth, NC | $91.30 | $70.61 – $92.58 | 687 | 2 |
| Hill Afb, UT | $3.45 | $2.56 – $8.02 | 688 | 2 |
| Boiceville, NY | $99.51 | $99.51 – $99.51 | 689 | 1 |
| Burdine, KY | $39.12 | $39.12 – $39.12 | 689 | 1 |
| Plumville, PA | $36.64 | $32.85 – $38.56 | 689 | 2 |
| Chaffee, MO | $28.12 | $28.12 – $28.12 | 690 | 1 |
| Hattieville, AR | $31.64 | $31.64 – $31.64 | 691 | 1 |
| Fairburn, GA | $23.79 | $23.79 – $23.79 | 691 | 1 |
| Jonestown, PA | $49.48 | $48.09 – $49.61 | 692 | 2 |
| Powers, MI | $22.05 | $22.05 – $22.05 | 693 | 1 |
| Sutter Creek, CA | $215.49 | $30.10 – $880.95 | 693 | 2 |
| Mountain, WI | $21.50 | $20.28 – $24.61 | 694 | 2 |
| Qulin, MO | $36.42 | $36.42 – $36.42 | 694 | 1 |
| Paint Lick, KY | $32.95 | $32.95 – $32.95 | 695 | 1 |
| Howard, PA | $36.91 | $36.91 – $36.91 | 695 | 1 |
| Long Beach Township, NJ | $33.47 | $33.47 – $33.47 | 696 | 1 |
| Rainier, OR | $71.48 | $71.39 – $75.21 | 696 | 2 |
| Fortdefiance, AZ | $13.29 | $13.29 – $13.29 | 697 | 1 |
| Mc Donald, OH | $34.79 | $34.79 – $34.79 | 697 | 1 |
| Summerset, SD | $95.40 | $95.40 – $95.40 | 698 | 1 |
| Indianapolisq, IN | $59.43 | $59.43 – $59.43 | 698 | 1 |
| Jamestown, PA | $46.68 | $46.68 – $46.68 | 699 | 1 |
| Pottsboro, TX | $73.02 | $73.02 – $73.02 | 700 | 1 |
| Irondale, AL | $37.81 | $6.76 – $70.26 | 703 | 4 |
| Ironton, MN | $98.62 | $98.62 – $98.62 | 703 | 1 |
| Hillsdale, NY | $104.78 | $104.78 – $104.78 | 703 | 1 |
| Modena, NY | $104.23 | $69.55 – $110.58 | 703 | 4 |
| Carl Junction, MO | $58.34 | $58.34 – $58.34 | 708 | 1 |
| Philo, IL | $48.04 | $48.04 – $48.04 | 708 | 1 |
| Madison, NE | $107.32 | $66.25 – $117.63 | 708 | 2 |
| Corrigan, TX | $11.20 | $11.20 – $11.20 | 709 | 1 |
| Cibecue, AZ | $144.26 | $144.26 – $144.26 | 709 | 1 |
| Fort Meyers, FL | $30.58 | $30.58 – $30.58 | 712 | 1 |
| Spencer, NC | $0.32 | $0.32 – $0.32 | 713 | 1 |
| W Sayville, NY | $54.81 | $54.81 – $54.81 | 713 | 1 |
| Osakis, MN | $49.63 | $49.63 – $49.63 | 713 | 1 |
| Browerville, MN | $132.94 | $132.94 – $132.94 | 715 | 1 |
| Poolesville, MD | $118.27 | $118.27 – $118.27 | 715 | 1 |
| Blue Grass, IA | $35.20 | $24.55 – $35.43 | 716 | 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.