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 |
|---|---|---|---|---|
| Georgetown, GA | $73.67 | $73.67 – $73.67 | 1,686 | 1 |
| W. Covina, CA | $15.25 | $15.25 – $15.25 | 1,686 | 1 |
| Ashland, MT | $0.00 | $0.00 – $0.00 | 1,686 | 1 |
| Decatur, AR | $22.51 | $0.59 – $22.69 | 1,686 | 2 |
| East Walpole, MA | $57.34 | $50.58 – $67.96 | 1,687 | 4 |
| Germantown Hills, IL | $71.29 | $71.29 – $71.29 | 1,688 | 1 |
| Santa Fe, TX | $38.88 | $23.76 – $100.17 | 1,689 | 3 |
| New York, NC | $180.90 | $180.90 – $180.90 | 1,691 | 1 |
| Jamul, CA | $3.57 | $3.57 – $3.57 | 1,692 | 1 |
| Fort Greely, AK | $545.79 | $545.79 – $545.79 | 1,696 | 1 |
| Gallipolis Ferry, WV | $14.13 | $13.43 – $98.70 | 1,698 | 2 |
| Canterbury, CT | $67.68 | $67.68 – $67.68 | 1,699 | 1 |
| Ivins, UT | $85.84 | $85.84 – $85.84 | 1,700 | 1 |
| Niagara, WI | $38.02 | $18.04 – $42.56 | 1,701 | 2 |
| Sutherland, IA | $33.04 | $33.04 – $33.04 | 1,703 | 1 |
| Wagener, SC | $38.46 | $38.46 – $38.46 | 1,704 | 1 |
| Kentfield, CA | $2.53 | $1.95 – $3.06 | 1,704 | 3 |
| Pawnee City, NE | $80.95 | $21.98 – $90.73 | 1,704 | 6 |
| Elmwood, NE | $76.53 | $76.53 – $76.53 | 1,705 | 1 |
| Central, SC | $66.98 | $56.88 – $70.62 | 1,707 | 3 |
| Nixon, NV | $15.29 | $0.00 – $35.81 | 1,710 | 2 |
| Marsing, ID | $1.04 | $1.04 – $1.04 | 1,711 | 1 |
| Harman, WV | $23.64 | $9.70 – $27.25 | 1,713 | 2 |
| Jefferson, OR | $96.56 | $96.56 – $96.56 | 1,716 | 1 |
| Smithfield, NE | $54.55 | $54.55 – $54.55 | 1,717 | 1 |
| Chincoteague, VA | $59.01 | $48.83 – $72.39 | 1,718 | 3 |
| Vilonia, AR | $26.45 | $0.19 – $50.65 | 1,718 | 7 |
| Forest Hill, WV | $4.02 | $0.00 – $81.30 | 1,718 | 3 |
| A.P.O., CA | $12.16 | $12.16 – $12.16 | 1,719 | 1 |
| Kidron, OH | $52.30 | $52.30 – $52.30 | 1,719 | 1 |
| Waterbury Center, VT | $22.01 | $22.01 – $22.01 | 1,720 | 1 |
| Colonial Beach, VA | $51.83 | $51.83 – $51.83 | 1,721 | 1 |
| Henderson, NE | $76.46 | $19.23 – $130.43 | 1,721 | 5 |
| Wauregan, CT | $83.91 | $83.91 – $83.91 | 1,722 | 1 |
| Freedom, WI | $42.79 | $42.79 – $42.79 | 1,722 | 1 |
| Cisco, TX | $37.97 | $13.00 – $39.71 | 1,723 | 3 |
| Coxsackie, NY | $74.92 | $1.05 – $78.51 | 1,726 | 4 |
| Kanarraville, UT | $55.72 | $55.72 – $55.72 | 1,726 | 1 |
| Centerbrook, CT | $52.81 | $28.72 – $55.39 | 1,728 | 2 |
| Blissfield, MI | $46.45 | $46.45 – $46.45 | 1,731 | 1 |
| Silt, CO | $43.60 | $43.60 – $43.60 | 1,731 | 1 |
| So Hadley, MA | $35.62 | $35.62 – $35.62 | 1,732 | 1 |
| Meridianville, AL | $16.89 | $0.13 – $50.58 | 1,733 | 4 |
| Nellis, WV | $54.97 | $50.19 – $56.40 | 1,734 | 2 |
| Wellsville, OH | $30.32 | $27.29 – $114.77 | 1,735 | 2 |
| Wall, SD | $61.05 | $60.60 – $76.15 | 1,735 | 2 |
| Reynoldsville, PA | $45.15 | $29.31 – $48.54 | 1,735 | 3 |
| Logan Township, NJ | $11.34 | $2.02 – $18.23 | 1,736 | 2 |
| Jackman, ME | $1.44 | $1.44 – $1.44 | 1,738 | 1 |
| East Rochester, NY | $85.91 | $85.91 – $85.91 | 1,739 | 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.