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 |
|---|---|---|---|---|
| Weston, MO | $19.48 | $19.48 – $19.48 | 3,162 | 1 |
| Elmer, NJ | $56.58 | $4.55 – $100.66 | 3,163 | 8 |
| West Point, NY | $53.90 | $29.40 – $141.47 | 3,165 | 3 |
| North St Paul, MN | $71.39 | $65.75 – $81.62 | 3,167 | 5 |
| Brockway, PA | $38.61 | $36.37 – $39.08 | 3,169 | 2 |
| Franktown, CO | $78.75 | $77.19 – $84.96 | 3,170 | 2 |
| Munnsville, NY | $72.28 | $72.06 – $73.39 | 3,170 | 2 |
| Green Bank, WV | $17.48 | $0.07 – $52.11 | 3,172 | 3 |
| Rostraver Twp, PA | $33.19 | $19.48 – $53.86 | 3,173 | 5 |
| Cusick, WA | $36.33 | $36.24 – $59.93 | 3,174 | 2 |
| Wilton, NY | $48.97 | $38.26 – $74.00 | 3,175 | 5 |
| Madelia, MN | $62.79 | $29.08 – $122.76 | 3,178 | 9 |
| Coconut Grove, FL | $40.66 | $32.18 – $114.29 | 3,179 | 4 |
| Cumming, IA | $35.37 | $34.68 – $35.72 | 3,182 | 2 |
| Richmond, VT | $38.02 | $13.92 – $74.00 | 3,187 | 7 |
| Highland Village, TX | $85.15 | $40.52 – $115.82 | 3,187 | 5 |
| Hoyleton, IL | $0.00 | $0.00 – $0.00 | 3,190 | 1 |
| Livingston Manor, NY | $156.53 | $156.53 – $156.53 | 3,192 | 1 |
| Pittsburg, PA | $69.70 | $69.70 – $69.70 | 3,194 | 1 |
| Hurley, NY | $70.69 | $18.70 – $70.99 | 3,195 | 2 |
| Cayuga, IN | $49.67 | $47.03 – $50.91 | 3,205 | 3 |
| Palm Beach, FL | $77.73 | $0.00 – $441.27 | 3,206 | 8 |
| Climax, NC | $55.24 | $55.24 – $55.24 | 3,206 | 1 |
| Star Lake, NY | $111.06 | $23.63 – $115.38 | 3,207 | 4 |
| Harmon, GU | $78.49 | $78.49 – $78.49 | 3,208 | 1 |
| Pride, LA | $39.10 | $39.07 – $39.10 | 3,208 | 2 |
| Emerald Isle, NC | $39.34 | $16.66 – $44.88 | 3,209 | 2 |
| Roaring Spring, PA | $40.01 | $28.83 – $66.80 | 3,209 | 6 |
| Chesaning, MI | $56.76 | $41.22 – $60.59 | 3,209 | 3 |
| Holden, MO | $66.35 | $66.35 – $66.35 | 3,211 | 1 |
| Oregon, MO | $87.26 | $87.26 – $87.26 | 3,211 | 1 |
| Pocasset, MA | $31.90 | $26.60 – $41.59 | 3,211 | 2 |
| Ulster Park, NY | $55.36 | $53.54 – $57.29 | 3,214 | 2 |
| Crozet, VA | $57.65 | $43.49 – $66.48 | 3,214 | 3 |
| Columbia, OH | $37.27 | $37.27 – $37.27 | 3,214 | 1 |
| Nespelem, WA | $42.78 | $0.68 – $48.23 | 3,218 | 4 |
| Orwell, OH | $41.45 | $32.25 – $48.07 | 3,219 | 3 |
| Vanleer, TN | $43.39 | $43.39 – $43.39 | 3,219 | 1 |
| St John, IN | $63.90 | $34.00 – $71.77 | 3,219 | 6 |
| Garden Valley, ID | $61.98 | $56.86 – $64.99 | 3,219 | 3 |
| West Sayville, NY | $76.67 | $35.54 – $110.77 | 3,220 | 5 |
| Valley City, OH | $38.36 | $17.66 – $49.07 | 3,222 | 4 |
| Golbert, AZ | $46.30 | $46.30 – $46.30 | 3,224 | 1 |
| Childress, TX | $25.10 | $13.52 – $59.88 | 3,225 | 4 |
| Franktown, VA | $48.24 | $47.68 – $58.29 | 3,226 | 2 |
| Hamburg, MI | $70.41 | $70.41 – $70.41 | 3,227 | 1 |
| Ada, MN | $106.33 | $87.29 – $119.48 | 3,228 | 4 |
| Pilot Mountain, NC | $57.75 | $49.78 – $64.32 | 3,230 | 6 |
| Hazen, ND | $161.35 | $111.33 – $245.04 | 3,230 | 5 |
| Talent, OR | $67.43 | $2.76 – $89.30 | 3,232 | 9 |
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.