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 |
|---|---|---|---|---|
| Deposit, NY | $62.16 | $46.31 – $67.08 | 4,607 | 5 |
| Evans Mills, NY | $47.63 | $43.61 – $67.57 | 4,604 | 5 |
| Betsy Layne, KY | $38.52 | $38.52 – $38.52 | 4,602 | 1 |
| Bolton Landing, NY | $69.95 | $42.68 – $86.65 | 4,600 | 4 |
| Sheridan, OR | $49.57 | $49.57 – $49.57 | 4,598 | 1 |
| Sublimity, OR | $40.79 | $16.95 – $64.85 | 4,595 | 6 |
| Montvale, NJ | $56.60 | $22.31 – $120.40 | 4,594 | 10 |
| Hayden Lake, ID | $6.80 | $6.00 – $52.04 | 4,592 | 2 |
| Sherman, ME | $38.63 | $21.10 – $47.82 | 4,591 | 3 |
| Walpole, NH | $20.24 | $4.88 – $46.62 | 4,588 | 3 |
| Carnegie, OK | $79.72 | $3.05 – $437.55 | 4,587 | 4 |
| Sedan, KS | $120.72 | $98.29 – $140.67 | 4,586 | 3 |
| Playa Del Rey, CA | $4.29 | $4.29 – $4.29 | 4,584 | 1 |
| Dunseith, ND | $162.78 | $137.20 – $206.18 | 4,584 | 2 |
| Bowler, WI | $26.88 | $24.62 – $37.95 | 4,583 | 5 |
| Clayton, AL | $42.31 | $0.00 – $188.33 | 4,582 | 3 |
| Florence, CO | $74.13 | $47.29 – $80.02 | 4,581 | 4 |
| Bicknell, UT | $50.23 | $5.86 – $108.47 | 4,579 | 2 |
| West Liberty, IA | $24.08 | $13.01 – $29.96 | 4,577 | 4 |
| Pisgah Forest, NC | $45.98 | $28.29 – $58.77 | 4,572 | 2 |
| Mexia, TX | $48.95 | $32.25 – $67.82 | 4,569 | 6 |
| Kingston, RI | $64.29 | $31.93 – $75.97 | 4,566 | 6 |
| Peterson Afb, CO | $76.89 | $63.23 – $83.33 | 4,566 | 5 |
| Tohatchi, NM | $105.10 | $29.56 – $106.99 | 4,565 | 3 |
| Port Isabel, TX | $28.36 | $0.00 – $28.76 | 4,565 | 3 |
| New Bloomfield, PA | $39.64 | $39.63 – $40.29 | 4,564 | 2 |
| Itta Bena, MS | $31.07 | $14.90 – $34.83 | 4,562 | 3 |
| Orange Grove, TX | $19.28 | $10.40 – $30.09 | 4,557 | 3 |
| Dunnville, KY | $45.22 | $45.22 – $45.22 | 4,554 | 1 |
| New Preston, CT | $73.90 | $68.37 – $143.76 | 4,552 | 2 |
| Aica, HI | $37.66 | $37.66 – $37.66 | 4,548 | 1 |
| Wanaque, NJ | $71.39 | $70.89 – $74.75 | 4,547 | 2 |
| Elk Rapids, MI | $59.00 | $44.19 – $61.88 | 4,545 | 2 |
| Council, ID | $32.23 | $0.00 – $58.26 | 4,543 | 6 |
| Sea Cliff, NY | $66.68 | $65.27 – $124.40 | 4,543 | 2 |
| Warm Springs, GA | $74.51 | $70.79 – $112.36 | 4,541 | 3 |
| Antrim, NH | $86.04 | $83.59 – $142.91 | 4,538 | 3 |
| Hardeeville, SC | $88.23 | $61.75 – $197.69 | 4,534 | 4 |
| Cloverdale, CA | $11.51 | $2.21 – $43.73 | 4,528 | 5 |
| Marble Hill, MO | $43.25 | $14.12 – $58.42 | 4,525 | 3 |
| Willow Park, TX | $46.09 | $2.07 – $71.53 | 4,525 | 13 |
| Newberry, IN | $48.59 | $47.64 – $52.39 | 4,515 | 2 |
| Ellicottville, NY | $103.74 | $72.07 – $112.85 | 4,510 | 3 |
| Oriskany Falls, NY | $52.82 | $49.87 – $67.12 | 4,509 | 2 |
| Dexter, MI | $126.44 | $44.25 – $209.61 | 4,509 | 5 |
| Round Lake, IL | $0.23 | $0.17 – $15.34 | 4,507 | 2 |
| Eddystone, PA | $48.40 | $10.40 – $57.53 | 4,505 | 4 |
| Greenfield, NH | $38.94 | $38.94 – $38.94 | 4,504 | 1 |
| Blades, DE | $41.96 | $24.21 – $48.26 | 4,503 | 2 |
| Georgia, VT | $79.74 | $25.56 – $89.84 | 4,502 | 3 |
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.