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 |
|---|---|---|---|---|
| Stephens, AR | $54.45 | $54.45 – $54.45 | 2,411 | 1 |
| Naples, NY | $62.86 | $56.07 – $65.47 | 2,412 | 2 |
| Wynnewood, OK | $19.11 | $19.11 – $19.11 | 2,412 | 1 |
| Mccloud, OK | $575.63 | $575.63 – $575.63 | 2,412 | 1 |
| Rosepine, LA | $0.00 | $0.00 – $0.00 | 2,413 | 1 |
| Medford, OK | $94.12 | $94.12 – $94.12 | 2,415 | 1 |
| Ubly, MI | $6.46 | $6.25 – $6.66 | 2,416 | 2 |
| Lake City, MN | $59.85 | $24.79 – $158.69 | 2,417 | 12 |
| Voorhees Township, NJ | $52.21 | $52.21 – $52.21 | 2,417 | 1 |
| Parker, PA | $35.02 | $31.37 – $42.35 | 2,418 | 3 |
| Culver, IN | $47.78 | $26.81 – $59.70 | 2,419 | 4 |
| Whitesville, KY | $29.06 | $28.72 – $29.08 | 2,419 | 2 |
| Sf, CA | $48.10 | $32.53 – $127.20 | 2,420 | 2 |
| Greenwich, OH | $40.92 | $39.26 – $41.04 | 2,421 | 2 |
| Shishmaref, AK | $395.35 | $31.72 – $435.16 | 2,422 | 7 |
| Braidwood, IL | $61.15 | $61.15 – $61.15 | 2,423 | 1 |
| Needham Heights, MA | $72.88 | $72.88 – $72.88 | 2,429 | 1 |
| Mableton, GA | $8.38 | $2.68 – $23.99 | 2,430 | 3 |
| Rockford, OH | $51.57 | $32.51 – $64.21 | 2,430 | 4 |
| Aspers, PA | $68.02 | $43.94 – $107.74 | 2,431 | 5 |
| North Saint Paul, MN | $73.07 | $63.38 – $76.05 | 2,432 | 4 |
| Southampton, MA | $79.79 | $24.57 – $87.46 | 2,432 | 4 |
| Berne, NY | $53.76 | $53.36 – $55.01 | 2,432 | 2 |
| Fort Leavenworth, KS | $40.66 | $25.13 – $81.46 | 2,432 | 5 |
| Basin, WY | $13.28 | $0.00 – $153.90 | 2,434 | 4 |
| Center, MO | $41.84 | $41.84 – $41.84 | 2,435 | 1 |
| Furlong, PA | $50.12 | $46.58 – $52.58 | 2,436 | 3 |
| Liberal, MO | $38.18 | $27.51 – $117.48 | 2,436 | 3 |
| Center Point, TX | $30.25 | $30.25 – $30.25 | 2,440 | 1 |
| Cerrillos, NM | $117.47 | $67.32 – $136.56 | 2,440 | 2 |
| Bunnell, FL | $144.93 | $0.00 – $153.31 | 2,445 | 6 |
| Taylor, PA | $37.26 | $10.27 – $61.33 | 2,445 | 3 |
| Arthur, IL | $25.98 | $0.00 – $71.12 | 2,445 | 3 |
| Okc, OK | $11.83 | $3.95 – $94.67 | 2,453 | 3 |
| Reedsville, PA | $38.21 | $32.82 – $42.05 | 2,453 | 4 |
| Darby, MT | $0.09 | $0.09 – $0.09 | 2,455 | 1 |
| Eatonton, GA | $52.42 | $0.00 – $124.64 | 2,457 | 10 |
| Tijeras, NM | $65.80 | $52.96 – $65.94 | 2,458 | 2 |
| Shoshone, ID | $1.62 | $0.85 – $2.32 | 2,461 | 2 |
| Red Fox, KY | $19.96 | $9.81 – $35.91 | 2,463 | 2 |
| Oshkosh, NE | $91.90 | $18.56 – $95.45 | 2,464 | 3 |
| Elroy, WI | $59.27 | $28.07 – $65.79 | 2,465 | 3 |
| Watertown, MN | $57.34 | $41.19 – $70.68 | 2,465 | 5 |
| Wyncote, PA | $3.14 | $0.00 – $49.08 | 2,465 | 5 |
| Gouldsboro, ME | $24.80 | $21.42 – $28.17 | 2,471 | 4 |
| Indialantic, FL | $52.16 | $5.47 – $62.67 | 2,471 | 5 |
| Kalaheo, HI | $44.00 | $6.46 – $317.65 | 2,471 | 11 |
| Cottage Grove, WI | $30.50 | $17.90 – $42.42 | 2,474 | 13 |
| Offutt Afb, NE | $93.70 | $14.28 – $142.64 | 2,475 | 11 |
| S. Burlington, VT | $18.53 | $13.93 – $26.07 | 2,477 | 7 |
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.