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 |
|---|---|---|---|---|
| Townsend, MT | $99.52 | $99.52 – $99.52 | 26 | 1 |
| Steamboat Spgs, CO | $73.19 | $73.19 – $73.19 | 26 | 1 |
| Strafford, PA | $67.69 | $66.92 – $68.46 | 26 | 2 |
| West Winfield, NY | $61.54 | $61.54 – $61.54 | 26 | 1 |
| Lost Springs, KS | $39.47 | $39.47 – $39.47 | 26 | 1 |
| Moran, KS | $69.97 | $69.97 – $69.97 | 26 | 1 |
| Stanley, NY | $48.29 | $48.29 – $48.29 | 26 | 1 |
| Livingsten, NJ | $120.00 | $120.00 – $120.00 | 26 | 1 |
| Chelsea, VT | $53.61 | $53.61 – $53.61 | 27 | 1 |
| Big Island, VA | $81.10 | $81.10 – $81.10 | 27 | 1 |
| Waverly, PA | $1.20 | $1.20 – $1.20 | 27 | 1 |
| Ouzinkie, AK | $0.00 | $0.00 – $0.00 | 27 | 1 |
| Ft Benning, GA | $23.60 | $23.60 – $23.60 | 27 | 1 |
| Orient, NY | $66.30 | $66.30 – $66.30 | 27 | 1 |
| No Hollywood, CA | $22.44 | $22.44 – $22.44 | 27 | 1 |
| Yorktown, TX | $55.26 | $55.26 – $55.26 | 27 | 1 |
| Kiana, AK | $0.00 | $0.00 – $0.00 | 27 | 1 |
| Kingsville, OH | $41.58 | $41.58 – $41.58 | 27 | 1 |
| Salt Lake Cty, UT | $79.18 | $79.18 – $79.18 | 27 | 1 |
| Scott Air Force Base, IL | $5.25 | $0.00 – $10.90 | 27 | 2 |
| Midland City, AL | $21.08 | $21.08 – $21.08 | 27 | 1 |
| New Haven, MO | $90.79 | $90.79 – $90.79 | 27 | 1 |
| Chalkyitsik, AK | $426.59 | $426.59 – $426.59 | 28 | 1 |
| Silverdale, PA | $48.56 | $48.56 – $48.56 | 28 | 1 |
| Dayton, PA | $0.00 | $0.00 – $0.00 | 28 | 1 |
| Lawson, MO | $57.49 | $57.49 – $57.49 | 28 | 1 |
| Ded Ham, MA | $73.10 | $73.10 – $73.10 | 28 | 1 |
| Middlesex, NY | $97.26 | $97.26 – $97.26 | 28 | 1 |
| Pinsonfork, KY | $38.71 | $38.71 – $38.71 | 28 | 1 |
| Ocate, NM | $84.47 | $84.47 – $84.47 | 28 | 1 |
| Sheffield, MA | $19.73 | $19.73 – $19.73 | 28 | 1 |
| Saint Bernard, LA | $31.03 | $31.03 – $31.03 | 28 | 1 |
| Pocomoke, MD | $93.74 | $93.74 – $93.74 | 28 | 1 |
| St Croix Falls, WI | $43.71 | $43.71 – $43.71 | 28 | 1 |
| New Albin, IA | $295.98 | $295.98 – $295.98 | 28 | 1 |
| Warrenville Hts, OH | $40.77 | $40.77 – $40.77 | 28 | 1 |
| Buffalo, SD | $33.09 | $33.09 – $33.09 | 29 | 1 |
| Hughes, AK | $434.70 | $434.70 – $434.70 | 29 | 1 |
| Dunmore, WV | $46.98 | $46.98 – $46.98 | 29 | 1 |
| Montgomery, IL | $60.61 | $60.61 – $60.61 | 29 | 1 |
| Long Bech, CA | $41.22 | $41.22 – $41.22 | 29 | 1 |
| Pleasant Plains, IL | $33.57 | $33.57 – $33.57 | 29 | 1 |
| Chesterfield, IN | $36.83 | $36.83 – $36.83 | 29 | 1 |
| Cicra, PR | $445.97 | $445.97 – $445.97 | 29 | 1 |
| Grand Forks Afb, ND | $64.79 | $64.79 – $64.79 | 29 | 1 |
| Grayling, AK | $438.58 | $438.58 – $438.58 | 29 | 1 |
| Otto, NC | $30.07 | $30.07 – $30.07 | 29 | 1 |
| Harpswell, ME | $29.01 | $29.01 – $29.01 | 29 | 1 |
| Coon Valley, WI | $15.61 | $15.20 – $15.96 | 30 | 2 |
| Whitewood, SD | $25.03 | $25.03 – $25.03 | 30 | 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.