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 |
|---|---|---|---|---|
| Hubert, NC | $54.56 | $54.56 – $54.56 | 30 | 1 |
| Gakona, AK | $205.15 | $205.15 – $205.15 | 30 | 1 |
| Coon Valley, WI | $15.61 | $15.20 – $15.96 | 30 | 2 |
| Whitewood, SD | $25.03 | $25.03 – $25.03 | 30 | 1 |
| Johnston, SC | $43.10 | $43.10 – $43.10 | 30 | 1 |
| Ruby, SC | $223.12 | $223.12 – $223.12 | 30 | 1 |
| Meadville, MO | $89.67 | $89.67 – $89.67 | 30 | 1 |
| Uncasvill, CT | $45.37 | $45.37 – $45.37 | 30 | 1 |
| Long Lake, MN | $39.55 | $17.75 – $61.35 | 30 | 2 |
| Wendover, UT | $89.90 | $89.90 – $89.90 | 30 | 1 |
| Niland, CA | $1.45 | $1.45 – $1.45 | 30 | 1 |
| Alma, WI | $10.56 | $10.56 – $10.56 | 30 | 1 |
| Tarpon Spgs, FL | $100.28 | $100.28 – $100.28 | 30 | 1 |
| Langdon, ND | $116.79 | $116.79 – $116.79 | 31 | 1 |
| Toulon, IL | $0.00 | $0.00 – $0.00 | 31 | 1 |
| Stonecrest, GA | $0.00 | $0.00 – $0.00 | 31 | 1 |
| Houston, Tx, TX | $35.99 | $35.99 – $35.99 | 31 | 1 |
| Valley Station, KY | $0.00 | $0.00 – $0.00 | 31 | 1 |
| Colmar, PA | $59.49 | $59.49 – $59.49 | 31 | 1 |
| N Stratford, NH | $76.03 | $76.03 – $76.03 | 31 | 1 |
| Manchaca, TX | $886.85 | $886.85 – $886.85 | 31 | 1 |
| N Kansas City, MO | $36.91 | $36.91 – $36.91 | 31 | 1 |
| Cummington, MA | $0.00 | $0.00 – $0.00 | 31 | 1 |
| Rindge, NH | $57.64 | $57.64 – $57.64 | 31 | 1 |
| Sherwood, OH | $49.28 | $49.28 – $49.28 | 31 | 1 |
| Berkeley, IL | $21.27 | $21.27 – $21.27 | 31 | 1 |
| Crested Butte, CT | $171.36 | $171.36 – $171.36 | 31 | 1 |
| Schaefferstown, PA | $36.55 | $36.55 – $36.55 | 31 | 1 |
| White Mountain, AK | $429.72 | $429.72 – $429.72 | 31 | 1 |
| Garnet Valley, PA | $40.00 | $40.00 – $40.00 | 32 | 1 |
| Fairfax, CA | $52.17 | $52.17 – $52.17 | 32 | 1 |
| Kenilworth, IL | $15.91 | $15.91 – $15.91 | 32 | 1 |
| Chateaugay, NY | $108.78 | $108.78 – $108.78 | 32 | 1 |
| Munice, IN | $76.83 | $76.83 – $76.83 | 32 | 1 |
| Arlington, MD | $108.50 | $108.50 – $108.50 | 32 | 1 |
| Stanhope, NJ | $104.05 | $104.05 – $104.05 | 32 | 1 |
| Urbana, MO | $98.79 | $98.79 – $98.79 | 32 | 1 |
| Oxford, WI | $41.34 | $41.34 – $41.34 | 32 | 1 |
| Bradford, OH | $18.06 | $18.06 – $18.06 | 32 | 1 |
| North Apollo, PA | $36.90 | $13.35 – $56.53 | 33 | 2 |
| Crane, TX | $0.91 | $0.91 – $0.91 | 33 | 1 |
| Buna, TX | $8.19 | $8.19 – $8.19 | 33 | 1 |
| Wayland, IA | $0.00 | $0.00 – $0.00 | 33 | 1 |
| Woodcliff Lake, NJ | $41.78 | $41.78 – $41.78 | 33 | 1 |
| Warm Springs, VA | $16.00 | $16.00 – $16.00 | 33 | 1 |
| Oxford, NE | $76.91 | $76.91 – $76.91 | 33 | 1 |
| Frametown, WV | $9.23 | $9.23 – $9.23 | 33 | 1 |
| Shageluk, AK | $0.00 | $0.00 – $0.00 | 33 | 1 |
| Cowen, WV | $44.49 | $44.49 – $44.49 | 33 | 1 |
| Merriville, IN | $28.32 | $28.32 – $28.32 | 33 | 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.