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 |
|---|---|---|---|---|
| St Clair, MI | $41.33 | $41.33 – $41.33 | 1,321 | 1 |
| Hartford, SD | $40.82 | $31.66 – $40.92 | 1,322 | 2 |
| Rose City, MI | $40.68 | $30.20 – $53.31 | 1,323 | 2 |
| St Clairsville, OH | $25.28 | $25.28 – $25.28 | 1,324 | 1 |
| Union, OR | $11.88 | $1.91 – $26.69 | 1,325 | 2 |
| Ocean View, HI | $79.82 | $32.22 – $89.56 | 1,325 | 2 |
| Mont Belvieu, TX | $61.42 | $26.97 – $122.18 | 1,325 | 3 |
| Hollsopple, PA | $0.00 | $0.00 – $0.00 | 1,327 | 2 |
| Davis, WV | $16.65 | $0.00 – $34.37 | 1,327 | 3 |
| Grenville, SC | $33.35 | $33.35 – $33.35 | 1,328 | 1 |
| Frankfort, OH | $33.96 | $33.96 – $33.96 | 1,328 | 1 |
| Ocean Gate, NJ | $16.13 | $16.13 – $16.13 | 1,330 | 1 |
| Mars Hill, NC | $32.86 | $22.30 – $92.37 | 1,330 | 6 |
| La Harpe, IL | $0.02 | $0.02 – $0.02 | 1,331 | 1 |
| Bolivar, OH | $10.79 | $2.76 – $36.56 | 1,332 | 5 |
| Falls, PA | $0.01 | $0.00 – $0.01 | 1,334 | 2 |
| Saint Anthony, MN | $122.42 | $84.85 – $147.11 | 1,334 | 2 |
| Tigerton, WI | $40.51 | $21.52 – $58.31 | 1,335 | 3 |
| Jaffrey, NH | $53.03 | $23.29 – $59.08 | 1,335 | 6 |
| La Crosse, KS | $26.29 | $0.00 – $26.55 | 1,336 | 2 |
| Allen, OK | $65.43 | $62.73 – $76.26 | 1,337 | 2 |
| Ridgway, CO | $73.07 | $60.67 – $233.34 | 1,341 | 4 |
| Point Hope, AK | $23.95 | $0.00 – $27.93 | 1,341 | 2 |
| Glen Allan, MS | $65.44 | $65.44 – $65.44 | 1,343 | 1 |
| South Haven, MN | $68.61 | $68.61 – $68.61 | 1,344 | 1 |
| Jonesville, FL | $30.07 | $0.00 – $30.94 | 1,346 | 2 |
| Eolia, KY | $33.40 | $33.40 – $33.40 | 1,348 | 1 |
| Manawa, WI | $36.68 | $36.68 – $36.68 | 1,349 | 1 |
| Roseboro, NC | $45.30 | $45.30 – $45.30 | 1,349 | 1 |
| Grdn Grove, CA | $9.60 | $9.60 – $9.60 | 1,349 | 1 |
| Earlysville, VA | $44.24 | $44.09 – $47.54 | 1,351 | 2 |
| Oakland, NE | $88.89 | $56.79 – $113.62 | 1,351 | 4 |
| Vinemont, AL | $43.11 | $23.04 – $44.05 | 1,352 | 2 |
| Bay Harbor Islands, FL | $7.94 | $0.76 – $96.15 | 1,352 | 7 |
| Dillwyn, VA | $64.77 | $63.67 – $79.46 | 1,353 | 2 |
| Elbridge, NY | $87.54 | $63.76 – $119.61 | 1,354 | 5 |
| Emlenton, PA | $63.36 | $36.24 – $63.71 | 1,355 | 2 |
| Vestavia Hls, AL | $41.68 | $41.33 – $52.14 | 1,356 | 2 |
| Sharpsburg, GA | $42.25 | $21.93 – $86.82 | 1,356 | 8 |
| Elgin, ND | $27.91 | $1.36 – $123.75 | 1,359 | 4 |
| Wyoming, PA | $32.63 | $32.63 – $32.63 | 1,359 | 1 |
| Keedysville, MD | $135.46 | $135.46 – $135.46 | 1,359 | 1 |
| Hoonah, AK | $265.29 | $52.67 – $789.29 | 1,360 | 4 |
| Quilcene, WA | $52.01 | $27.99 – $82.08 | 1,360 | 4 |
| Vincent, AL | $69.59 | $69.59 – $69.59 | 1,360 | 1 |
| Sherburne, NY | $34.71 | $21.58 – $72.04 | 1,360 | 6 |
| Jarrettsville, MD | $16.83 | $12.51 – $78.50 | 1,361 | 4 |
| Olney, TX | $16.32 | $5.92 – $30.68 | 1,361 | 3 |
| Wessington Springs, SD | $118.06 | $42.76 – $123.90 | 1,361 | 2 |
| Piedmont, WV | $17.15 | $7.91 – $24.43 | 1,362 | 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.