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 |
|---|---|---|---|---|
| Haddam, CT | $97.92 | $97.92 – $97.92 | 2,268 | 1 |
| Honeoye, NY | $68.56 | $66.68 – $72.14 | 2,269 | 3 |
| Hanson, KY | $35.73 | $35.73 – $35.73 | 2,269 | 1 |
| Pittsburg, TX | $32.52 | $15.29 – $52.75 | 2,270 | 3 |
| Shickshinny, PA | $0.02 | $0.00 – $0.02 | 2,270 | 2 |
| Magnolia, NJ | $58.59 | $1.29 – $63.08 | 2,271 | 3 |
| Griswold, CT | $25.78 | $25.10 – $27.88 | 2,272 | 2 |
| Mcewen, TN | $32.03 | $23.04 – $32.17 | 2,275 | 2 |
| Cotto Laurel, PR | $24.86 | $24.86 – $24.86 | 2,278 | 1 |
| Glendale, OR | $0.37 | $0.33 – $0.80 | 2,279 | 2 |
| New Kent, VA | $65.49 | $13.43 – $69.40 | 2,280 | 3 |
| University Park, PA | $27.86 | $25.15 – $34.87 | 2,280 | 5 |
| Cleveland, AL | $2.74 | $0.00 – $38.29 | 2,281 | 4 |
| Mount Horeb, WI | $26.38 | $12.25 – $30.96 | 2,281 | 6 |
| Steelville, MO | $33.67 | $12.83 – $107.31 | 2,282 | 4 |
| Buckley, WA | $42.34 | $39.47 – $82.04 | 2,282 | 5 |
| Taft, OK | $80.98 | $77.01 – $89.41 | 2,282 | 2 |
| Harleysville, PA | $13.97 | $1.67 – $46.05 | 2,283 | 10 |
| Hanover Township, PA | $36.51 | $26.88 – $36.63 | 2,283 | 2 |
| Sister Bay, WI | $31.74 | $27.44 – $51.82 | 2,283 | 5 |
| College Point, NY | $50.99 | $0.80 – $114.35 | 2,288 | 9 |
| Grayville, IL | $10.98 | $0.00 – $37.74 | 2,289 | 2 |
| Snyder, TX | $37.11 | $14.17 – $137.65 | 2,290 | 6 |
| State Center, IA | $0.32 | $0.24 – $0.96 | 2,290 | 2 |
| Reedsville, OH | $51.20 | $51.20 – $51.20 | 2,291 | 1 |
| Sandston, VA | $48.75 | $48.75 – $48.75 | 2,291 | 1 |
| Pleasant Valley, NY | $96.24 | $70.11 – $118.09 | 2,292 | 3 |
| Cascade, IA | $33.14 | $25.73 – $39.32 | 2,293 | 3 |
| Terry, MT | $0.00 | $0.00 – $0.00 | 2,297 | 1 |
| Deerfield, KS | $167.47 | $167.47 – $167.47 | 2,299 | 1 |
| Carlisle, IN | $56.51 | $38.93 – $60.03 | 2,299 | 4 |
| Stony Point, NC | $31.06 | $31.06 – $31.06 | 2,307 | 1 |
| Cresskill, NJ | $43.49 | $34.57 – $57.42 | 2,307 | 3 |
| Cissna Park, IL | $0.00 | $0.00 – $0.00 | 2,310 | 2 |
| Quantico, VA | $39.83 | $6.62 – $129.88 | 2,312 | 4 |
| Panville, KY | $28.13 | $28.13 – $28.13 | 2,312 | 1 |
| Alpha, IL | $61.59 | $61.59 – $61.59 | 2,317 | 1 |
| Tioga, ND | $72.55 | $56.87 – $179.58 | 2,318 | 8 |
| Lewiston Me, ME | $47.25 | $47.25 – $47.25 | 2,318 | 1 |
| Bay, AR | $30.61 | $5.82 – $33.46 | 2,318 | 3 |
| Cotuit, MA | $24.16 | $7.78 – $50.26 | 2,319 | 4 |
| Hemphill, TX | $31.61 | $28.83 – $37.21 | 2,319 | 2 |
| Universal City, TX | $44.30 | $33.04 – $53.79 | 2,321 | 3 |
| Rogersville, PA | $45.74 | $0.17 – $63.02 | 2,321 | 2 |
| Stromsburg, NE | $64.27 | $58.30 – $68.14 | 2,322 | 2 |
| San Felipe, NM | $353.14 | $15.73 – $485.07 | 2,323 | 2 |
| Port Ewen, NY | $76.31 | $76.31 – $76.31 | 2,325 | 1 |
| Hamburg, AR | $70.64 | $35.10 – $72.62 | 2,326 | 2 |
| Hurlock, MD | $37.63 | $23.47 – $37.93 | 2,327 | 2 |
| Downieville, CA | $10.86 | $9.17 – $12.51 | 2,329 | 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.