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 |
|---|---|---|---|---|
| Plainville, KS | $46.92 | $22.74 – $149.22 | 1,591 | 7 |
| Spartansburg, PA | $1.63 | $0.00 – $1.88 | 1,593 | 2 |
| Zephyr Cove, NV | $29.67 | $28.15 – $38.38 | 1,595 | 2 |
| Lancaster, MO | $68.08 | $11.10 – $70.80 | 1,597 | 3 |
| Granby, CO | $126.07 | $0.00 – $171.40 | 1,597 | 5 |
| Norfolk, VI | $120.69 | $120.69 – $120.69 | 1,598 | 1 |
| Hubertus, WI | $42.20 | $42.20 – $42.20 | 1,598 | 1 |
| Lovlenad, CO | $76.26 | $76.26 – $76.26 | 1,598 | 1 |
| Pierce, NE | $59.04 | $56.41 – $70.97 | 1,600 | 2 |
| Corning, OH | $41.65 | $41.65 – $41.65 | 1,601 | 1 |
| Lousiville, KY | $69.89 | $69.89 – $69.89 | 1,602 | 1 |
| Gilmer, TX | $21.41 | $0.00 – $47.77 | 1,604 | 7 |
| Maria Stein, OH | $46.91 | $37.88 – $56.39 | 1,604 | 2 |
| Shattuck, OK | $107.75 | $21.85 – $122.19 | 1,605 | 3 |
| Fairview, TX | $91.82 | $38.69 – $327.82 | 1,605 | 3 |
| Edgewood, IA | $0.11 | $0.00 – $0.31 | 1,606 | 2 |
| Mcfarland, WI | $17.93 | $14.47 – $30.00 | 1,606 | 3 |
| Bessemer City, NC | $11.73 | $1.26 – $66.94 | 1,606 | 2 |
| Timber Lake, SD | $92.47 | $92.47 – $92.47 | 1,606 | 1 |
| Senoia, GA | $97.97 | $41.39 – $135.80 | 1,608 | 4 |
| Apollo, PA | $31.34 | $2.66 – $36.72 | 1,608 | 2 |
| Dacono, CO | $52.91 | $51.80 – $53.63 | 1,609 | 2 |
| Jasper, FL | $19.98 | $19.88 – $21.17 | 1,611 | 2 |
| Mountville, PA | $82.97 | $5.70 – $93.64 | 1,613 | 4 |
| Manchester, MA | $46.71 | $3.70 – $60.62 | 1,614 | 10 |
| Waddell, AZ | $44.17 | $5.78 – $72.87 | 1,614 | 3 |
| Van Etten, NY | $48.86 | $48.86 – $48.86 | 1,616 | 1 |
| Powellsville, NC | $13.80 | $13.80 – $13.80 | 1,616 | 1 |
| Sheboygan Falls, WI | $38.06 | $23.82 – $42.28 | 1,617 | 5 |
| Kiel, WI | $42.30 | $27.32 – $161.56 | 1,618 | 7 |
| Boiling Spring Lakes, NC | $20.92 | $20.92 – $20.92 | 1,618 | 1 |
| Ridgeway, SC | $128.51 | $114.01 – $170.80 | 1,618 | 2 |
| Felton, DE | $12.57 | $0.00 – $20.91 | 1,619 | 3 |
| Ullin, IL | $11.88 | $11.88 – $11.88 | 1,619 | 1 |
| Suamico, WI | $28.38 | $21.79 – $69.60 | 1,623 | 4 |
| Saltsburg, PA | $35.60 | $35.18 – $36.80 | 1,624 | 3 |
| Orleans, MA | $51.56 | $0.00 – $71.67 | 1,625 | 8 |
| Mckees Rocks, PA | $38.27 | $22.98 – $52.42 | 1,625 | 4 |
| Saddle River, NJ | $51.53 | $33.94 – $67.81 | 1,625 | 3 |
| Beach, ND | $108.23 | $7.35 – $118.59 | 1,627 | 3 |
| Clarksboro, NJ | $28.77 | $8.66 – $31.01 | 1,627 | 2 |
| Karlstad, MN | $44.62 | $44.62 – $44.62 | 1,627 | 1 |
| Ambridge, PA | $44.60 | $32.23 – $48.41 | 1,630 | 4 |
| Baileyville, ME | $25.97 | $25.97 – $25.97 | 1,630 | 1 |
| Adrian, OR | $121.57 | $121.57 – $121.57 | 1,631 | 1 |
| New Caney, TX | $39.93 | $9.07 – $134.91 | 1,632 | 4 |
| Abita Springs, LA | $37.19 | $0.00 – $48.65 | 1,632 | 5 |
| Fountain Vly, CA | $68.16 | $68.16 – $68.16 | 1,632 | 1 |
| Louisburg, KS | $191.94 | $27.15 – $215.46 | 1,633 | 4 |
| East Rancho Dominguez, CA | $33.70 | $0.00 – $35.97 | 1,633 | 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.