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 |
|---|---|---|---|---|
| Conway Springs, KS | $173.05 | $173.05 – $173.05 | 716 | 1 |
| Cranbury, NJ | $30.15 | $27.44 – $32.20 | 717 | 2 |
| Castle Point, NY | $27.40 | $26.47 – $34.09 | 718 | 2 |
| Glenburnie, MD | $113.39 | $113.39 – $113.39 | 718 | 1 |
| Rockawy Park, NY | $57.24 | $57.24 – $57.24 | 719 | 1 |
| Rising Star, TX | $489.78 | $489.78 – $489.78 | 720 | 1 |
| Jacobus, PA | $34.18 | $34.18 – $34.18 | 721 | 1 |
| South Waverly, PA | $92.67 | $92.67 – $92.67 | 721 | 1 |
| Concordia, MO | $63.51 | $62.59 – $110.42 | 722 | 2 |
| Gordonsville, VA | $37.04 | $37.04 – $37.04 | 723 | 1 |
| Ararat, VA | $64.75 | $64.75 – $64.75 | 723 | 1 |
| Navarre, OH | $30.23 | $30.23 – $30.23 | 723 | 1 |
| Browns Valley, MN | $57.93 | $57.93 – $57.93 | 725 | 1 |
| Hull, IA | $35.16 | $35.16 – $35.16 | 726 | 1 |
| Irwindale, CA | $827.44 | $39.68 – $1,233 | 726 | 4 |
| Cane Ridge, TN | $46.75 | $46.75 – $46.75 | 726 | 1 |
| Chinchilla, PA | $0.63 | $0.63 – $0.63 | 727 | 1 |
| Masontown, WV | $100.48 | $81.89 – $102.03 | 728 | 2 |
| Bethesda, OH | $92.82 | $92.82 – $92.82 | 730 | 1 |
| Rockville, CT | $85.50 | $85.50 – $85.50 | 730 | 1 |
| Silver Bay, MN | $79.45 | $79.45 – $79.45 | 730 | 1 |
| Caledonia, WI | $42.10 | $40.42 – $46.54 | 731 | 2 |
| Kobuk, AK | $92.87 | $85.30 – $102.53 | 731 | 2 |
| Burns, WY | $46.17 | $46.17 – $46.17 | 732 | 1 |
| Arapaho, WY | $0.82 | $0.82 – $0.82 | 732 | 1 |
| Gaston, OR | $108.01 | $108.01 – $108.01 | 733 | 1 |
| Newtok, AK | $438.72 | $438.72 – $438.72 | 734 | 1 |
| Carney, OK | $17.04 | $17.04 – $17.04 | 735 | 1 |
| Cold Spring, NY | $68.92 | $24.62 – $82.83 | 735 | 3 |
| Des Moines, ID | $45.19 | $45.19 – $45.19 | 735 | 1 |
| Niagara University, NY | $68.87 | $68.87 – $68.87 | 735 | 1 |
| Freemont, CA | $9.67 | $9.67 – $9.67 | 735 | 1 |
| Whiteville, TN | $42.15 | $30.02 – $48.66 | 736 | 2 |
| Campaign, IL | $45.19 | $45.19 – $45.19 | 736 | 1 |
| Hermon, NY | $69.78 | $69.78 – $69.78 | 736 | 1 |
| Holland, NY | $44.20 | $44.20 – $44.20 | 738 | 1 |
| Kermit, TX | $34.70 | $34.28 – $55.06 | 738 | 2 |
| Bartlett, NE | $62.46 | $62.46 – $62.46 | 738 | 1 |
| Merion Station, PA | $44.44 | $44.44 – $44.44 | 739 | 1 |
| Ferendale, CA | $9.20 | $9.20 – $9.20 | 739 | 1 |
| Allison, IA | $5.73 | $0.60 – $6.32 | 739 | 2 |
| Represa, CA | $1.61 | $1.61 – $1.61 | 740 | 1 |
| New Hope, AL | $61.18 | $58.61 – $66.74 | 740 | 2 |
| Allendale, NJ | $38.30 | $38.30 – $38.30 | 741 | 1 |
| Dupont, WA | $38.94 | $2.26 – $62.29 | 742 | 3 |
| Froestville, NY | $61.69 | $61.69 – $61.69 | 742 | 1 |
| Camden, IN | $51.80 | $51.80 – $51.80 | 743 | 1 |
| Cainsville, MO | $75.91 | $68.76 – $103.77 | 744 | 2 |
| South Bound Brook, NJ | $63.00 | $63.00 – $63.00 | 744 | 1 |
| East Norristown, PA | $38.34 | $38.34 – $38.34 | 746 | 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.