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 |
|---|---|---|---|---|
| Stuart, NE | $68.50 | $48.53 – $90.91 | 972 | 3 |
| Thurmond, NC | $70.69 | $70.69 – $70.69 | 973 | 1 |
| Spanish Valley, UT | $71.53 | $71.53 – $71.53 | 973 | 1 |
| Killean, TX | $43.39 | $43.39 – $43.39 | 973 | 1 |
| Abingdon, IL | $0.00 | $0.00 – $0.00 | 974 | 1 |
| Galena, MD | $31.38 | $31.38 – $31.38 | 974 | 1 |
| Saratoga Spgs, NY | $60.93 | $44.93 – $67.51 | 975 | 4 |
| Attica, NY | $65.14 | $49.71 – $75.92 | 976 | 4 |
| Jemison, AL | $39.26 | $29.65 – $46.93 | 976 | 2 |
| Oakes, ND | $76.62 | $51.50 – $142.98 | 977 | 7 |
| Magnolia, DE | $0.55 | $0.55 – $0.55 | 978 | 1 |
| Geismar, LA | $3.35 | $0.00 – $36.43 | 978 | 2 |
| Fancy Farm, KY | $24.79 | $24.79 – $24.79 | 980 | 1 |
| Caldwell, WV | $44.01 | $0.00 – $69.01 | 982 | 3 |
| Covington, OH | $29.69 | $21.45 – $31.69 | 982 | 3 |
| Laurel Springs, NJ | $22.04 | $2.42 – $47.96 | 982 | 3 |
| Baileys Crossroads, VA | $4.21 | $3.85 – $33.39 | 982 | 2 |
| Elk Horn, IA | $14.15 | $0.17 – $19.08 | 983 | 2 |
| Saint Stephens Church, VA | $45.10 | $41.78 – $69.07 | 984 | 2 |
| Oak Ridge, NJ | $9.58 | $5.16 – $27.49 | 984 | 3 |
| Eglon, WV | $15.96 | $0.00 – $20.86 | 984 | 3 |
| Eureka, SD | $76.72 | $76.72 – $76.72 | 986 | 1 |
| Ellicott, MD | $136.22 | $136.22 – $136.22 | 986 | 1 |
| Worrester, MA | $84.77 | $84.77 – $84.77 | 986 | 1 |
| Salt Point, NY | $103.19 | $98.86 – $117.51 | 988 | 2 |
| Ethridge, TN | $18.15 | $18.15 – $18.15 | 988 | 1 |
| La Plata, MO | $58.58 | $32.06 – $67.85 | 988 | 2 |
| Sugar Grove, VA | $49.94 | $49.94 – $49.94 | 989 | 1 |
| Ramona, OK | $78.44 | $66.01 – $79.38 | 989 | 2 |
| Elk Horn, KY | $30.33 | $30.33 – $30.33 | 989 | 1 |
| Westbrook, MN | $132.98 | $124.27 – $164.37 | 990 | 3 |
| Newhebron, MS | $83.38 | $62.68 – $121.73 | 990 | 2 |
| Delmar, DE | $33.08 | $3.18 – $120.74 | 992 | 5 |
| Christoval, TX | $39.26 | $39.26 – $39.26 | 992 | 1 |
| Hamilton, TX | $63.83 | $5.87 – $94.66 | 992 | 4 |
| Bell Buckle, TN | $33.98 | $33.98 – $33.98 | 993 | 1 |
| Plainfield, NY | $169.89 | $169.89 – $169.89 | 993 | 1 |
| Satsuma, AL | $10.61 | $10.61 – $10.61 | 994 | 1 |
| W Hartford, CT | $39.47 | $30.73 – $43.49 | 995 | 3 |
| Stonington, CT | $46.57 | $46.57 – $46.57 | 996 | 1 |
| Oakland, IL | $1.10 | $0.00 – $54.79 | 996 | 2 |
| Mars Hill, ME | $23.54 | $23.54 – $23.54 | 996 | 1 |
| Leeds, NY | $95.26 | $95.26 – $95.26 | 998 | 1 |
| Cheyenne, OK | $88.37 | $66.38 – $119.44 | 998 | 3 |
| Eudora, AR | $7.30 | $0.00 – $17.51 | 998 | 4 |
| Elverson, PA | $41.39 | $0.22 – $55.40 | 999 | 3 |
| Wpafb, OH | $75.46 | $44.77 – $109.90 | 999 | 5 |
| Cresco, PA | $43.16 | $43.16 – $43.16 | 1,000 | 1 |
| Plainsfield, NJ | $5.37 | $5.37 – $5.37 | 1,000 | 1 |
| Fountain Green, UT | $36.27 | $36.27 – $36.27 | 1,001 | 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.