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 |
|---|---|---|---|---|
| Wappingers Fallls, NY | $91.62 | $91.62 – $91.62 | 6,543 | 1 |
| Wayland, MA | $45.12 | $0.48 – $128.39 | 6,542 | 11 |
| Twisp, WA | $27.48 | $16.36 – $65.39 | 6,540 | 7 |
| Delano, MN | $51.57 | $39.89 – $83.89 | 6,533 | 7 |
| Disputanta, VA | $46.71 | $46.71 – $46.71 | 6,532 | 1 |
| Dyess Afb, TX | $63.41 | $51.78 – $101.28 | 6,528 | 3 |
| Hill City, SD | $66.12 | $35.41 – $80.19 | 6,527 | 5 |
| Brusly, LA | $35.85 | $33.09 – $37.06 | 6,525 | 2 |
| Lake Milton, OH | $51.82 | $51.82 – $51.82 | 6,522 | 1 |
| Heathrow, FL | $26.73 | $9.22 – $66.16 | 6,519 | 3 |
| Highland, UT | $48.81 | $48.53 – $64.92 | 6,519 | 4 |
| Thorp, WI | $41.30 | $14.07 – $50.16 | 6,512 | 4 |
| Countryside, IL | $50.58 | $31.58 – $85.26 | 6,511 | 4 |
| Dalton, OH | $21.67 | $1.90 – $28.40 | 6,505 | 3 |
| Oakdale, NY | $81.74 | $12.97 – $186.89 | 6,504 | 9 |
| Ellisville, MO | $57.78 | $23.07 – $115.39 | 6,503 | 14 |
| Bethel, VT | $7.42 | $1.64 – $72.15 | 6,502 | 4 |
| Annandale, MN | $74.84 | $62.25 – $92.01 | 6,501 | 7 |
| Newyork, NY | $99.51 | $85.60 – $179.94 | 6,498 | 2 |
| Fredericksted, VI | $157.25 | $157.25 – $157.25 | 6,495 | 1 |
| Branchland, WV | $8.00 | $0.58 – $10.96 | 6,493 | 2 |
| Guin, AL | $42.08 | $4.18 – $75.63 | 6,493 | 4 |
| Winnebago, IL | $53.50 | $48.94 – $62.11 | 6,486 | 4 |
| Alb, NM | $106.78 | $50.52 – $107.11 | 6,486 | 3 |
| Weddington, NC | $74.93 | $74.93 – $74.93 | 6,483 | 1 |
| Breckenridge, MN | $48.86 | $28.35 – $73.45 | 6,481 | 6 |
| Ontonagon, MI | $33.87 | $30.40 – $43.71 | 6,481 | 3 |
| Lac Du Flambeau, WI | $26.10 | $0.00 – $35.36 | 6,474 | 8 |
| Homosassa, FL | $49.21 | $20.29 – $59.96 | 6,472 | 6 |
| Helenwood, TN | $30.59 | $30.59 – $30.59 | 6,467 | 1 |
| Lyons Falls, NY | $96.08 | $71.26 – $106.18 | 6,461 | 7 |
| Clay, NY | $73.58 | $0.00 – $97.98 | 6,460 | 4 |
| Belle, MO | $79.89 | $76.58 – $101.91 | 6,459 | 2 |
| San Fidel, NM | $58.90 | $30.38 – $99.88 | 6,458 | 3 |
| Umatilla, FL | $27.02 | $0.00 – $86.09 | 6,457 | 7 |
| Red Lion, PA | $54.90 | $42.46 – $62.02 | 6,454 | 12 |
| Mathews, VA | $62.53 | $41.89 – $74.74 | 6,452 | 8 |
| Latta, SC | $218.47 | $205.43 – $336.01 | 6,447 | 3 |
| Sussex, NJ | $12.37 | $12.37 – $12.37 | 6,444 | 1 |
| Merrimac, MA | $50.29 | $50.29 – $50.29 | 6,434 | 1 |
| Fort Huachuca, AZ | $127.14 | $49.44 – $161.68 | 6,433 | 3 |
| Millville, DE | $69.20 | $1.96 – $148.37 | 6,432 | 6 |
| Castle Dale, UT | $73.68 | $73.68 – $73.68 | 6,428 | 1 |
| Saranac, MI | $10.79 | $10.79 – $10.79 | 6,426 | 1 |
| Ocean Shores, WA | $25.89 | $17.27 – $63.35 | 6,426 | 5 |
| Logandale, NV | $42.40 | $42.40 – $42.40 | 6,419 | 1 |
| New Havend, CT | $13.03 | $13.03 – $13.03 | 6,416 | 1 |
| Summerdale, AL | $49.35 | $47.24 – $109.33 | 6,415 | 4 |
| Hi Hat, KY | $32.21 | $32.21 – $32.21 | 6,414 | 1 |
| Andrews, SC | $65.45 | $39.71 – $130.55 | 6,411 | 6 |
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.