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 |
|---|---|---|---|---|
| Meshoppen, PA | $55.75 | $55.75 – $55.75 | 773 | 1 |
| Calais, VT | $6.07 | $6.07 – $6.07 | 774 | 1 |
| Taylor, AR | $71.38 | $71.38 – $71.38 | 774 | 1 |
| Patterson, NC | $0.32 | $0.32 – $0.32 | 774 | 1 |
| Wakarusa, IN | $42.75 | $23.20 – $54.97 | 775 | 2 |
| Cambridge, IL | $0.80 | $0.80 – $0.80 | 775 | 1 |
| Bluffdale, UT | $86.71 | $61.55 – $91.12 | 776 | 3 |
| St Marys, GA | $47.49 | $47.49 – $47.49 | 776 | 1 |
| Smelterville, ID | $46.08 | $3.89 – $55.75 | 777 | 2 |
| W Islip, NY | $67.94 | $67.94 – $67.94 | 777 | 1 |
| Black Jack, MO | $12.78 | $12.78 – $12.78 | 778 | 1 |
| Kirtland Afb, NM | $101.18 | $5.56 – $150.23 | 778 | 3 |
| Fraser, CO | $241.42 | $43.40 – $420.69 | 779 | 3 |
| Chatfield, MN | $44.30 | $43.42 – $47.30 | 780 | 2 |
| Michigan Center, MI | $130.62 | $130.62 – $130.62 | 780 | 1 |
| Cook, MN | $219.88 | $116.00 – $301.72 | 780 | 6 |
| Ottertail, MN | $164.63 | $164.63 – $164.63 | 780 | 1 |
| Green Forest, AR | $25.65 | $25.58 – $28.26 | 781 | 2 |
| Salemburg, NC | $40.88 | $6.60 – $43.99 | 782 | 2 |
| Wildwood, GA | $5.02 | $5.02 – $5.02 | 782 | 1 |
| Turmersville, NJ | $40.46 | $40.46 – $40.46 | 782 | 1 |
| Morrill, ME | $28.80 | $28.80 – $28.80 | 783 | 1 |
| West Logan, WV | $32.26 | $32.26 – $32.26 | 783 | 1 |
| New Palastine, IN | $40.41 | $40.41 – $40.41 | 783 | 1 |
| Silver Lake, OH | $55.13 | $55.13 – $55.13 | 783 | 1 |
| Shelbyville, MI | $3.01 | $3.01 – $3.01 | 785 | 1 |
| O'Donnell, TX | $35.69 | $0.00 – $36.38 | 786 | 2 |
| Mountain Iron, MN | $54.01 | $52.40 – $79.37 | 786 | 2 |
| Laurie, MO | $70.03 | $48.01 – $78.90 | 787 | 2 |
| Monson, MA | $38.55 | $36.29 – $45.35 | 789 | 2 |
| Mount Healthy, OH | $27.40 | $27.40 – $27.40 | 789 | 1 |
| Mitchell, NE | $301.28 | $301.28 – $301.28 | 789 | 1 |
| Westover, MD | $145.31 | $22.67 – $171.99 | 790 | 3 |
| Bay Point, CA | $25.71 | $25.71 – $25.71 | 791 | 1 |
| Beavercreek Township, OH | $23.87 | $23.87 – $23.87 | 791 | 1 |
| Cataumet, MA | $54.25 | $54.25 – $54.25 | 791 | 1 |
| Caldwell, TX | $26.06 | $0.00 – $29.47 | 792 | 3 |
| East Sandwich, MA | $31.82 | $25.72 – $58.23 | 793 | 4 |
| Searsport, ME | $47.83 | $47.83 – $47.83 | 793 | 1 |
| Mentone, CA | $66.47 | $66.47 – $66.47 | 793 | 1 |
| Palouse, WA | $35.89 | $22.59 – $37.25 | 795 | 2 |
| Windsor, MD | $137.75 | $137.75 – $137.75 | 797 | 1 |
| Halstead, KS | $73.20 | $36.21 – $141.51 | 797 | 2 |
| Lacenter, KY | $24.59 | $24.59 – $24.59 | 798 | 1 |
| Henrietta, TX | $36.43 | $35.29 – $100.32 | 799 | 2 |
| Bladenboro, NC | $29.53 | $0.00 – $53.26 | 799 | 5 |
| Hudson, IA | $30.81 | $30.81 – $30.81 | 799 | 1 |
| Liberty, TX | $27.47 | $2.66 – $32.64 | 799 | 6 |
| Burwell, NE | $126.29 | $106.07 – $140.81 | 800 | 3 |
| Charlton, NY | $58.61 | $35.28 – $59.96 | 801 | 3 |
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.