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 |
|---|---|---|---|---|
| Beacon Falls, CT | $35.06 | $0.00 – $39.51 | 1,003 | 3 |
| Grafton, MA | $6.29 | $5.63 – $60.60 | 1,004 | 2 |
| Goldens Bridge, NY | $96.18 | $51.25 – $190.47 | 1,005 | 3 |
| Fairfield, MT | $84.63 | $79.10 – $121.64 | 1,007 | 2 |
| Branchport, NY | $78.78 | $78.78 – $78.78 | 1,008 | 1 |
| Dallas Center, IA | $0.22 | $0.00 – $0.22 | 1,009 | 2 |
| N Brunswick, NJ | $39.71 | $39.30 – $39.79 | 1,010 | 2 |
| Horicon, WI | $24.64 | $24.64 – $24.64 | 1,010 | 1 |
| Copalis Beach, WA | $48.47 | $48.47 – $48.47 | 1,010 | 1 |
| Fort Irwin, CA | $44.94 | $0.00 – $78.28 | 1,012 | 4 |
| Linton, ND | $85.96 | $69.96 – $114.09 | 1,012 | 5 |
| Westby, WI | $39.41 | $19.80 – $62.30 | 1,013 | 6 |
| Warren, MN | $75.61 | $30.32 – $181.58 | 1,013 | 6 |
| Arcadia, OK | $125.13 | $125.13 – $125.13 | 1,014 | 1 |
| Woodville, TX | $30.53 | $4.67 – $35.28 | 1,014 | 5 |
| Easton, ME | $32.19 | $32.19 – $32.19 | 1,014 | 1 |
| Luthvle Timon, MD | $63.92 | $63.92 – $63.92 | 1,016 | 1 |
| Seagrove, NC | $48.73 | $28.68 – $53.86 | 1,017 | 2 |
| N Providence, RI | $49.28 | $48.86 – $50.24 | 1,017 | 2 |
| Roxbury, NY | $69.97 | $69.97 – $69.97 | 1,017 | 1 |
| Albany, TX | $28.29 | $0.00 – $56.83 | 1,018 | 5 |
| Roy, NM | $146.97 | $146.97 – $146.97 | 1,019 | 1 |
| Sandy Ridge, NC | $51.65 | $51.65 – $51.65 | 1,019 | 1 |
| Milton Freewater, OR | $48.57 | $31.15 – $56.91 | 1,020 | 2 |
| Gillette, NJ | $37.58 | $37.58 – $37.58 | 1,021 | 1 |
| St. Michael, MN | $72.34 | $72.34 – $72.34 | 1,023 | 1 |
| Mingo Jct, OH | $30.61 | $30.61 – $30.61 | 1,023 | 1 |
| Lavista, NE | $41.91 | $41.91 – $41.91 | 1,026 | 1 |
| Coalport, PA | $0.36 | $0.00 – $0.37 | 1,027 | 2 |
| Satellite Beach, FL | $52.92 | $49.31 – $56.33 | 1,028 | 3 |
| Circle, MT | $10.83 | $0.00 – $37.68 | 1,030 | 2 |
| Kernville, CA | $48.50 | $48.50 – $48.50 | 1,031 | 1 |
| St. Croix, VI | $96.96 | $96.96 – $96.96 | 1,032 | 1 |
| Nunam, AK | $389.39 | $389.39 – $389.39 | 1,033 | 1 |
| New Britain, PA | $43.69 | $33.60 – $45.70 | 1,034 | 2 |
| Rockwood, MI | $16.99 | $16.99 – $16.99 | 1,034 | 1 |
| Greenfield Township, PA | $0.00 | $0.00 – $0.00 | 1,034 | 1 |
| Washburn, ME | $6.11 | $6.11 – $6.11 | 1,035 | 1 |
| Mcclearly, WA | $50.00 | $50.00 – $50.00 | 1,036 | 1 |
| Barrett, MN | $56.72 | $56.72 – $56.72 | 1,037 | 1 |
| Secacus, NJ | $56.83 | $56.83 – $56.83 | 1,038 | 1 |
| Fruite Cove, FL | $42.01 | $42.01 – $42.01 | 1,038 | 1 |
| Rumson, NJ | $35.26 | $35.26 – $35.26 | 1,039 | 1 |
| Bayard, NE | $119.26 | $119.26 – $119.26 | 1,039 | 1 |
| Noxapater, MS | $37.26 | $37.26 – $37.26 | 1,041 | 1 |
| Angola, LA | $57.44 | $57.44 – $57.44 | 1,041 | 1 |
| Kimberly, AL | $67.33 | $66.61 – $67.80 | 1,041 | 2 |
| Manhattan, NY | $68.84 | $63.25 – $139.25 | 1,041 | 3 |
| Buzzards Bay, MA | $84.89 | $0.00 – $427.00 | 1,042 | 5 |
| Ripley, NY | $45.22 | $45.22 – $45.22 | 1,042 | 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.