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 |
|---|---|---|---|---|
| Franconia, NH | $34.19 | $0.00 – $110.81 | 2,132 | 5 |
| Canajonarie, NY | $22.38 | $22.38 – $22.38 | 2,134 | 1 |
| Summerville, GA | $38.90 | $3.25 – $79.74 | 2,135 | 2 |
| Marceline, MO | $82.16 | $79.82 – $85.46 | 2,136 | 2 |
| Nettie, WV | $0.03 | $0.03 – $0.03 | 2,138 | 1 |
| Brooklyn, CT | $15.97 | $0.56 – $23.04 | 2,139 | 3 |
| Hampton, CT | $0.00 | $0.00 – $0.00 | 2,139 | 1 |
| Glade Spring, VA | $72.96 | $10.72 – $412.95 | 2,140 | 6 |
| Rogers, KY | $37.36 | $37.36 – $37.36 | 2,145 | 1 |
| St. Mary'S, AK | $542.53 | $0.00 – $600.53 | 2,146 | 4 |
| Ranshaw, PA | $21.68 | $6.96 – $22.24 | 2,146 | 2 |
| Coyote, NM | $131.20 | $131.20 – $131.20 | 2,146 | 1 |
| Stockton, IL | $50.38 | $50.38 – $50.38 | 2,147 | 1 |
| Sandrock, AL | $0.55 | $0.55 – $0.55 | 2,149 | 1 |
| Mad River, CA | $0.88 | $0.00 – $0.90 | 2,151 | 2 |
| South Lake, TX | $0.05 | $0.05 – $0.05 | 2,153 | 1 |
| Lima, NY | $80.35 | $59.17 – $87.89 | 2,155 | 4 |
| Osborne, KS | $193.91 | $25.47 – $199.23 | 2,158 | 2 |
| Hawthrone, CA | $9.86 | $9.86 – $9.86 | 2,160 | 1 |
| Ferron, UT | $8.11 | $8.11 – $8.11 | 2,161 | 1 |
| Riverdale Park, MD | $58.88 | $57.93 – $64.39 | 2,161 | 2 |
| Arrington, TN | $11.70 | $11.70 – $11.70 | 2,166 | 1 |
| Galeton, PA | $0.05 | $0.05 – $0.05 | 2,166 | 1 |
| Masspequa, NY | $69.66 | $69.66 – $69.66 | 2,167 | 1 |
| Lawrence, NJ | $40.45 | $34.77 – $47.38 | 2,168 | 2 |
| Union Bridge, MD | $103.75 | $13.80 – $112.14 | 2,168 | 4 |
| Fort Stockton, TX | $28.35 | $0.00 – $59.66 | 2,169 | 7 |
| Alakanuk, AK | $49.21 | $0.00 – $233.51 | 2,170 | 4 |
| Eckert, CO | $18.90 | $0.00 – $50.78 | 2,176 | 4 |
| Mansfield, CT | $37.50 | $32.63 – $39.44 | 2,177 | 3 |
| Groves, TX | $32.19 | $0.00 – $38.18 | 2,178 | 3 |
| Hapeville, GA | $22.64 | $0.56 – $36.11 | 2,178 | 2 |
| Dassel, MN | $162.46 | $33.98 – $182.01 | 2,178 | 3 |
| Des Arc, AR | $22.99 | $0.61 – $30.34 | 2,179 | 3 |
| Washington Township, NJ | $42.87 | $42.87 – $42.87 | 2,182 | 1 |
| Waurika, OK | $185.98 | $69.89 – $223.88 | 2,183 | 3 |
| Bayard, NM | $99.30 | $9.31 – $107.17 | 2,187 | 2 |
| Spring Valley, AZ | $49.77 | $11.38 – $50.52 | 2,187 | 3 |
| Princeton, WI | $38.79 | $38.79 – $38.79 | 2,190 | 1 |
| Tanana, AK | $338.89 | $338.67 – $339.55 | 2,191 | 2 |
| Carrizozo, NM | $98.93 | $39.49 – $108.94 | 2,193 | 3 |
| Niagra Falls, NY | $84.13 | $84.13 – $84.13 | 2,194 | 1 |
| Mt. Vernon, NY | $40.34 | $15.55 – $67.81 | 2,195 | 2 |
| Clinton, MA | $61.64 | $30.03 – $78.90 | 2,195 | 7 |
| Olyphant, PA | $33.80 | $25.83 – $40.93 | 2,195 | 3 |
| Oakville, WA | $48.06 | $40.65 – $52.24 | 2,196 | 2 |
| Waite Park, MN | $72.44 | $50.63 – $113.80 | 2,198 | 6 |
| Donora, PA | $52.72 | $52.72 – $52.72 | 2,198 | 1 |
| Winlock, WA | $27.58 | $22.66 – $41.22 | 2,199 | 3 |
| North Berwick, ME | $30.50 | $30.49 – $30.97 | 2,201 | 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.