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 |
|---|---|---|---|---|
| Gardner, IL | $67.68 | $67.68 – $67.68 | 1,362 | 1 |
| Princeton, MO | $64.78 | $64.78 – $64.78 | 1,362 | 1 |
| Crockett, TX | $32.35 | $16.89 – $36.12 | 1,363 | 5 |
| Kapaau, HI | $159.83 | $149.72 – $161.97 | 1,364 | 3 |
| Smiths Station, AL | $49.47 | $23.89 – $69.26 | 1,366 | 2 |
| Capitan, NM | $50.54 | $50.54 – $50.54 | 1,367 | 1 |
| Genoa, IL | $42.96 | $39.01 – $43.25 | 1,368 | 3 |
| Faith, SD | $239.42 | $151.98 – $430.89 | 1,368 | 3 |
| Mountian View, AR | $26.93 | $26.93 – $26.93 | 1,368 | 1 |
| Strawberry, AR | $15.87 | $15.67 – $24.50 | 1,369 | 2 |
| Ft Washington, MD | $85.48 | $17.99 – $93.19 | 1,370 | 3 |
| Lizton, IN | $29.37 | $13.86 – $78.98 | 1,370 | 4 |
| Chuia Vista, CA | $48.36 | $48.36 – $48.36 | 1,371 | 1 |
| Gap, PA | $43.85 | $37.70 – $44.83 | 1,371 | 2 |
| Jordan, MN | $71.61 | $66.87 – $91.89 | 1,371 | 4 |
| Tuluksak, AK | $139.08 | $0.00 – $206.36 | 1,371 | 4 |
| Velma, OK | $222.93 | $221.46 – $228.76 | 1,371 | 2 |
| Earle, AR | $26.93 | $0.00 – $38.77 | 1,372 | 5 |
| Robesonia, PA | $83.99 | $77.00 – $101.83 | 1,373 | 4 |
| Tyrone, GA | $53.54 | $0.00 – $64.96 | 1,374 | 4 |
| Brookly, NY | $83.37 | $83.37 – $83.37 | 1,376 | 1 |
| Kimberling City, MO | $77.06 | $77.06 – $77.06 | 1,379 | 1 |
| North Judson, IN | $62.86 | $39.43 – $67.86 | 1,379 | 3 |
| Glenwood, IL | $26.15 | $0.00 – $33.26 | 1,381 | 4 |
| Citrus Hills, FL | $40.39 | $40.39 – $40.39 | 1,382 | 1 |
| Belton, SC | $31.99 | $31.99 – $31.99 | 1,384 | 1 |
| Beleville, WI | $32.71 | $11.83 – $33.37 | 1,384 | 2 |
| Valders, WI | $37.71 | $33.37 – $39.13 | 1,384 | 2 |
| Toa Altu, PR | $1.40 | $1.40 – $1.40 | 1,385 | 1 |
| Rayland, OH | $85.43 | $85.43 – $85.43 | 1,386 | 1 |
| Chocowinity, NC | $47.68 | $40.85 – $52.78 | 1,388 | 3 |
| Foster, RI | $50.43 | $46.00 – $57.21 | 1,388 | 2 |
| Nazareth, KY | $38.32 | $38.32 – $38.32 | 1,388 | 1 |
| Ligonier, PA | $40.23 | $38.27 – $49.88 | 1,389 | 5 |
| Hyrum, UT | $67.94 | $44.19 – $76.88 | 1,389 | 3 |
| Slickville, PA | $57.94 | $57.94 – $57.94 | 1,389 | 1 |
| Cordova, AL | $3.40 | $0.00 – $4.13 | 1,390 | 2 |
| West Newbury, VT | $67.10 | $67.10 – $67.10 | 1,390 | 1 |
| Queen City, MO | $63.33 | $63.33 – $63.33 | 1,391 | 1 |
| Quinter, KS | $34.68 | $26.03 – $50.92 | 1,391 | 3 |
| Waterford, ME | $44.37 | $44.37 – $44.37 | 1,391 | 1 |
| Breezy Point, NY | $77.21 | $77.21 – $77.21 | 1,391 | 1 |
| Mcarthur, OH | $40.60 | $40.60 – $40.60 | 1,392 | 1 |
| Wagram, NC | $25.30 | $3.19 – $43.29 | 1,393 | 2 |
| Ty Ty, GA | $58.78 | $58.78 – $58.78 | 1,394 | 1 |
| Covington, OK | $641.07 | $641.07 – $641.07 | 1,396 | 1 |
| Sandy Hook, VA | $25.50 | $25.50 – $25.50 | 1,397 | 1 |
| Tappan, NY | $85.41 | $53.76 – $106.15 | 1,398 | 5 |
| Chandler, TX | $43.14 | $22.92 – $48.01 | 1,398 | 5 |
| Diamond Springs, CA | $549.40 | $0.00 – $826.46 | 1,402 | 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.