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 |
|---|---|---|---|---|
| Downieville, CA | $10.86 | $9.17 – $12.51 | 2,329 | 2 |
| Whiting, VT | $46.16 | $4.72 – $50.18 | 2,329 | 2 |
| Llano, TX | $67.55 | $7.63 – $71.06 | 2,330 | 4 |
| Basehor, KS | $35.08 | $26.33 – $40.42 | 2,331 | 3 |
| Long Valley, NJ | $70.60 | $70.55 – $71.32 | 2,333 | 2 |
| Mcgregor, MN | $145.56 | $145.56 – $145.56 | 2,333 | 1 |
| Baudette, MN | $65.65 | $26.85 – $70.65 | 2,333 | 4 |
| E. Los Angeles, CA | $6.45 | $5.67 – $10.68 | 2,342 | 2 |
| Virden, IL | $3.25 | $3.25 – $3.25 | 2,343 | 1 |
| Cropseyville, NY | $56.73 | $54.42 – $57.99 | 2,344 | 2 |
| Berwyn, PA | $60.89 | $35.73 – $94.39 | 2,346 | 11 |
| Glennallen, AK | $323.19 | $116.32 – $582.07 | 2,348 | 3 |
| Rupert, WV | $79.44 | $79.44 – $79.44 | 2,350 | 1 |
| Cedarville, OH | $62.84 | $38.27 – $65.17 | 2,352 | 2 |
| Robert, LA | $6.28 | $6.28 – $6.28 | 2,354 | 1 |
| Ambst, NY | $38.91 | $38.91 – $38.91 | 2,358 | 1 |
| Broadlands, VA | $51.48 | $50.65 – $68.92 | 2,364 | 3 |
| Waldwick, NJ | $53.74 | $5.57 – $83.43 | 2,370 | 9 |
| Norwich, OH | $43.60 | $43.60 – $43.60 | 2,371 | 1 |
| Mc Donald, PA | $42.04 | $40.78 – $43.61 | 2,371 | 3 |
| Kronenwetter, WI | $30.31 | $22.52 – $40.92 | 2,372 | 3 |
| Panguitch, UT | $74.99 | $10.34 – $98.15 | 2,376 | 7 |
| Rockcave, WV | $0.87 | $0.00 – $0.98 | 2,378 | 2 |
| Derwood, MD | $91.32 | $41.27 – $91.66 | 2,378 | 2 |
| Courtland, VA | $46.73 | $15.30 – $60.83 | 2,379 | 4 |
| Damascus, VA | $39.03 | $34.06 – $86.91 | 2,380 | 2 |
| Akron, CO | $185.76 | $88.71 – $255.45 | 2,382 | 4 |
| Ocracoke, NC | $54.99 | $27.29 – $55.21 | 2,382 | 2 |
| Tripoli, IA | $23.13 | $22.84 – $24.82 | 2,383 | 2 |
| Morgan, UT | $71.68 | $14.73 – $79.21 | 2,384 | 4 |
| Pinehill, NM | $46.74 | $25.39 – $63.13 | 2,385 | 2 |
| Roch, NY | $76.54 | $76.54 – $76.54 | 2,385 | 1 |
| Castile, NY | $65.38 | $64.88 – $68.89 | 2,386 | 2 |
| Charleston, MA | $33.02 | $33.02 – $33.02 | 2,387 | 1 |
| Burlington Township, NJ | $61.59 | $56.73 – $127.12 | 2,389 | 4 |
| Corp Christi, TX | $9.12 | $0.00 – $9.22 | 2,389 | 2 |
| Syracuse, KS | $164.54 | $23.25 – $182.40 | 2,389 | 4 |
| Floral City, FL | $34.36 | $19.00 – $48.90 | 2,392 | 2 |
| Evergreen Pk, IL | $39.64 | $39.64 – $39.64 | 2,393 | 1 |
| Fairmount City, PA | $4.09 | $0.00 – $46.42 | 2,395 | 4 |
| Water Mill, NY | $99.74 | $98.26 – $116.01 | 2,401 | 2 |
| Salineville, OH | $31.51 | $31.51 – $31.51 | 2,401 | 1 |
| Tyndall, SD | $84.48 | $0.00 – $86.50 | 2,401 | 2 |
| Ottsville, PA | $44.66 | $43.89 – $69.46 | 2,403 | 3 |
| Adams, WI | $25.20 | $21.83 – $98.25 | 2,404 | 2 |
| Groesbeck, TX | $51.52 | $11.27 – $76.07 | 2,407 | 6 |
| Cheshire, OH | $64.93 | $57.06 – $118.42 | 2,408 | 2 |
| Middlebourne, WV | $18.13 | $0.37 – $80.67 | 2,408 | 4 |
| Short Hills, NJ | $70.80 | $3.47 – $114.78 | 2,408 | 8 |
| Berthoud, CO | $65.45 | $64.59 – $66.69 | 2,409 | 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.