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 |
|---|---|---|---|---|
| Goshen, KY | $42.66 | $38.57 – $42.77 | 1,403 | 2 |
| Freeland, MI | $48.23 | $45.49 – $73.81 | 1,404 | 2 |
| Griffithsville, WV | $50.06 | $50.06 – $50.06 | 1,405 | 1 |
| Eclectic, AL | $37.08 | $36.81 – $37.29 | 1,405 | 2 |
| Hempstead, TX | $58.68 | $38.25 – $83.43 | 1,405 | 3 |
| Elk Grove, IL | $65.09 | $44.46 – $66.00 | 1,406 | 2 |
| Orion, MI | $53.58 | $50.57 – $60.83 | 1,406 | 3 |
| Hosford, FL | $49.28 | $28.40 – $50.13 | 1,407 | 2 |
| Etowah, NC | $38.85 | $34.47 – $65.89 | 1,407 | 3 |
| Longville, LA | $32.54 | $32.54 – $32.54 | 1,408 | 1 |
| Freer, TX | $75.90 | $34.68 – $76.34 | 1,408 | 2 |
| Amelia Court House, VA | $30.43 | $30.43 – $30.43 | 1,409 | 1 |
| Given, WV | $44.84 | $44.84 – $44.84 | 1,410 | 1 |
| Rossville, IL | $0.00 | $0.00 – $0.00 | 1,415 | 1 |
| Wendell, ID | $5.07 | $5.07 – $5.07 | 1,415 | 1 |
| Wales, MA | $65.51 | $65.51 – $65.51 | 1,416 | 1 |
| Monon, IN | $61.77 | $49.73 – $66.58 | 1,417 | 2 |
| Elkland, PA | $2.32 | $2.20 – $10.70 | 1,418 | 2 |
| Ronks, PA | $209.98 | $74.12 – $211.73 | 1,418 | 2 |
| West Point, GA | $8.39 | $0.00 – $68.38 | 1,418 | 5 |
| Annendale, VI | $9.14 | $9.14 – $9.14 | 1,418 | 1 |
| Cherokee Vlg, AR | $36.19 | $36.19 – $36.19 | 1,419 | 1 |
| Overton, TX | $46.63 | $46.63 – $46.63 | 1,421 | 1 |
| Poplar Grove, IL | $14.98 | $14.98 – $14.98 | 1,423 | 1 |
| Pardeeville, WI | $20.48 | $20.48 – $20.48 | 1,425 | 1 |
| Sheffield, IA | $22.44 | $21.88 – $25.83 | 1,425 | 2 |
| Inarajan, GU | $28.39 | $28.39 – $28.39 | 1,426 | 1 |
| Suite 1, CT | $48.54 | $48.54 – $48.54 | 1,426 | 1 |
| Russian Mission, AK | $10.22 | $0.00 – $16.13 | 1,428 | 2 |
| Loyal, WI | $50.03 | $50.03 – $50.03 | 1,429 | 1 |
| Osceola, IN | $60.68 | $58.42 – $71.65 | 1,429 | 4 |
| Oostburg, WI | $45.02 | $45.02 – $45.02 | 1,430 | 1 |
| Ulysses, PA | $0.00 | $0.00 – $0.00 | 1,430 | 1 |
| Manchester, VT | $81.30 | $81.30 – $81.30 | 1,430 | 1 |
| Midway, KY | $43.20 | $42.15 – $53.35 | 1,431 | 2 |
| Douglass Hills, KY | $72.33 | $72.33 – $72.33 | 1,432 | 1 |
| Arundel, ME | $23.84 | $18.92 – $26.31 | 1,432 | 2 |
| 00612, PR | $5.32 | $5.32 – $5.32 | 1,432 | 1 |
| Kingston, MO | $16.85 | $16.85 – $16.85 | 1,437 | 1 |
| Fillmore, IN | $38.90 | $38.90 – $38.90 | 1,438 | 1 |
| Ferguson, NC | $40.62 | $36.20 – $41.35 | 1,439 | 2 |
| Hastings On Hudson, NY | $89.72 | $5.47 – $152.55 | 1,439 | 6 |
| Sharon Springs, KS | $163.56 | $163.56 – $163.56 | 1,440 | 1 |
| Ft. Thomas, KY | $59.91 | $28.51 – $62.45 | 1,442 | 3 |
| Cascade, ID | $3.78 | $0.00 – $4.26 | 1,443 | 6 |
| Teec Nos Pos, AZ | $157.76 | $20.56 – $359.99 | 1,443 | 3 |
| Tripler Amc, HI | $120.15 | $35.33 – $371.15 | 1,443 | 11 |
| Castl Rock, WA | $13.82 | $13.82 – $13.82 | 1,444 | 1 |
| New London, MO | $60.20 | $60.20 – $60.20 | 1,444 | 1 |
| Oakfield, NY | $70.55 | $70.55 – $70.55 | 1,444 | 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.