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 |
|---|---|---|---|---|
| Laotto, IN | $62.84 | $62.84 – $62.84 | 1,512 | 1 |
| Edmeston, NY | $51.90 | $41.42 – $69.57 | 1,512 | 3 |
| Ochelata, OK | $109.20 | $79.41 – $109.83 | 1,514 | 2 |
| Dousman, WI | $50.97 | $50.97 – $50.97 | 1,514 | 1 |
| Bottineau, ND | $128.51 | $0.43 – $390.41 | 1,517 | 7 |
| Harrison, TN | $50.34 | $5.17 – $52.05 | 1,517 | 3 |
| Milton, WI | $31.71 | $21.07 – $35.40 | 1,518 | 5 |
| Lakeside, MT | $86.53 | $86.53 – $86.53 | 1,519 | 1 |
| Woolwich Township, NJ | $74.11 | $0.53 – $107.34 | 1,519 | 7 |
| Birdsboro, PA | $49.84 | $38.42 – $70.17 | 1,522 | 3 |
| Caledonia, MN | $49.29 | $48.84 – $50.27 | 1,522 | 2 |
| Hayden, AL | $43.74 | $43.74 – $43.74 | 1,523 | 1 |
| Bolton, NC | $3.98 | $3.98 – $3.98 | 1,524 | 1 |
| North Baltimore, OH | $33.79 | $29.08 – $52.21 | 1,524 | 2 |
| Mpls, MN | $87.86 | $84.60 – $88.08 | 1,524 | 2 |
| Armada, MI | $57.32 | $0.00 – $57.78 | 1,525 | 2 |
| Hilbert, WI | $32.15 | $13.05 – $33.42 | 1,526 | 2 |
| Chatham, NY | $69.35 | $56.32 – $120.38 | 1,528 | 6 |
| Jonesburg, MO | $19.02 | $19.02 – $19.02 | 1,528 | 1 |
| Cantril, IA | $0.00 | $0.00 – $0.00 | 1,529 | 1 |
| Jessup, MD | $144.95 | $54.26 – $180.06 | 1,530 | 2 |
| St. Marys, PA | $66.12 | $29.68 – $67.02 | 1,531 | 2 |
| Claysville, PA | $47.64 | $27.96 – $51.78 | 1,531 | 6 |
| Coal City, WV | $17.67 | $16.66 – $21.21 | 1,531 | 2 |
| Mt Vernon, OH | $72.77 | $20.31 – $74.10 | 1,533 | 2 |
| Walsh, CO | $75.51 | $75.14 – $75.97 | 1,533 | 2 |
| Titus, AL | $42.51 | $42.51 – $42.51 | 1,534 | 1 |
| West Greenwich, RI | $48.75 | $48.75 – $48.75 | 1,534 | 1 |
| Seth, WV | $8.16 | $8.16 – $8.16 | 1,536 | 1 |
| Monahans, TX | $80.25 | $43.76 – $125.55 | 1,536 | 3 |
| High Piont, NC | $42.34 | $42.34 – $42.34 | 1,536 | 1 |
| Clear Spring, MD | $94.07 | $94.07 – $94.07 | 1,538 | 1 |
| Forest Hill, TX | $41.28 | $41.28 – $41.28 | 1,538 | 1 |
| English, IN | $47.05 | $47.05 – $47.05 | 1,538 | 1 |
| Lenore, WV | $72.57 | $72.57 – $72.57 | 1,538 | 1 |
| Presidio, TX | $1.06 | $0.29 – $7.78 | 1,540 | 2 |
| Canadian, TX | $0.00 | $0.00 – $0.00 | 1,542 | 4 |
| Packwood, WA | $56.82 | $56.82 – $56.82 | 1,542 | 1 |
| Ridgway, PA | $58.56 | $0.00 – $60.57 | 1,542 | 4 |
| Clinton, WI | $18.44 | $16.86 – $22.74 | 1,543 | 2 |
| Lone Pine, CA | $28.55 | $19.15 – $42.31 | 1,544 | 2 |
| Nickelsville, VA | $46.46 | $28.09 – $76.73 | 1,544 | 2 |
| Wanatah, IN | $64.85 | $64.85 – $64.85 | 1,545 | 1 |
| Air Force Academy, CO | $166.22 | $166.22 – $166.22 | 1,546 | 1 |
| Pine Island, MN | $55.11 | $42.37 – $64.55 | 1,546 | 4 |
| Johnson City, TX | $36.80 | $24.47 – $37.31 | 1,547 | 2 |
| Arlington, IA | $16.58 | $0.00 – $24.63 | 1,549 | 2 |
| New Franklin, OH | $36.98 | $36.98 – $36.98 | 1,549 | 1 |
| Stuttgart, AR | $34.14 | $5.24 – $39.07 | 1,551 | 4 |
| Poinciana, FL | $12.04 | $1.92 – $26.12 | 1,552 | 3 |
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.