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 |
|---|---|---|---|---|
| Neligh, NE | $68.26 | $44.14 – $156.93 | 4,401 | 8 |
| Seward, PA | $43.66 | $40.45 – $45.68 | 4,399 | 3 |
| Valdez, AK | $84.15 | $66.21 – $106.35 | 4,398 | 4 |
| Medfield, MA | $64.28 | $3.33 – $85.43 | 4,394 | 7 |
| Christiana, PA | $48.39 | $33.79 – $78.61 | 4,394 | 5 |
| Clinton, NY | $41.06 | $31.42 – $87.80 | 4,392 | 5 |
| North Hills, NV | $45.08 | $45.08 – $45.08 | 4,390 | 1 |
| Fall River Mills, CA | $4.58 | $0.38 – $43.70 | 4,389 | 6 |
| Neptune City, NJ | $59.98 | $5.21 – $86.26 | 4,389 | 9 |
| Wailea, HI | $76.63 | $11.69 – $78.70 | 4,388 | 3 |
| Excelsior, MN | $54.85 | $29.80 – $81.32 | 4,388 | 12 |
| Del Norte, CO | $52.71 | $24.15 – $407.39 | 4,388 | 10 |
| Nunica, MI | $190.88 | $190.88 – $190.88 | 4,383 | 1 |
| Holloman Afb, NM | $71.54 | $46.17 – $86.20 | 4,383 | 5 |
| South Salt Lake, UT | $67.15 | $14.13 – $99.83 | 4,382 | 10 |
| Levelland, TX | $42.80 | $0.00 – $90.48 | 4,381 | 16 |
| Shell Rock, IA | $23.04 | $0.05 – $32.35 | 4,380 | 2 |
| East Corinth, VT | $14.31 | $0.00 – $36.16 | 4,373 | 3 |
| Farwell, MI | $24.90 | $24.90 – $24.90 | 4,370 | 1 |
| Wapello, IA | $0.00 | $0.00 – $0.00 | 4,367 | 2 |
| Centerville, UT | $61.47 | $6.95 – $76.92 | 4,366 | 7 |
| Denton, NC | $33.50 | $33.50 – $33.50 | 4,366 | 1 |
| Jacksboro, TX | $13.69 | $0.00 – $28.43 | 4,365 | 6 |
| Glandorf, OH | $43.14 | $43.14 – $43.14 | 4,364 | 1 |
| Winthrop, WA | $53.05 | $35.48 – $76.04 | 4,363 | 9 |
| Menands, NY | $75.60 | $61.76 – $78.75 | 4,362 | 2 |
| Selawik, AK | $128.77 | $75.59 – $364.88 | 4,362 | 6 |
| Laughlin, NV | $50.93 | $0.00 – $51.21 | 4,359 | 3 |
| Coal Township, PA | $36.75 | $5.78 – $52.85 | 4,357 | 7 |
| Holly Ridge, NC | $38.47 | $37.37 – $41.70 | 4,355 | 2 |
| Afton, WY | $56.28 | $28.80 – $85.77 | 4,355 | 11 |
| E Greenwich, RI | $53.10 | $34.11 – $90.65 | 4,351 | 6 |
| Herington, KS | $85.15 | $25.73 – $221.32 | 4,351 | 6 |
| Hot Springs, MT | $0.00 | $0.00 – $0.00 | 4,349 | 1 |
| Monmouth Junction, NJ | $45.60 | $8.66 – $66.65 | 4,347 | 5 |
| Topmost, KY | $39.37 | $39.37 – $39.37 | 4,343 | 1 |
| Saint Johnsbury, VT | $11.31 | $0.59 – $93.31 | 4,341 | 5 |
| Absarokee, MT | $73.95 | $73.95 – $73.95 | 4,340 | 1 |
| Longville, MN | $160.01 | $160.01 – $160.01 | 4,338 | 1 |
| Sun Valley, NV | $50.95 | $0.00 – $55.29 | 4,337 | 4 |
| Woodlands, TX | $58.05 | $51.98 – $77.03 | 4,336 | 2 |
| Heathsville, VA | $47.52 | $33.18 – $59.66 | 4,336 | 6 |
| Delmont, PA | $49.66 | $33.37 – $55.71 | 4,335 | 9 |
| Waymart, PA | $2.72 | $2.19 – $27.22 | 4,334 | 2 |
| Mt Pleasant Mills, PA | $38.25 | $37.65 – $40.03 | 4,332 | 2 |
| Bethlehem, CT | $47.55 | $38.05 – $57.71 | 4,331 | 4 |
| Pendleton, SC | $63.99 | $35.65 – $281.73 | 4,331 | 6 |
| Mogadore, OH | $47.75 | $29.39 – $50.55 | 4,328 | 4 |
| Mound City, KS | $150.67 | $16.78 – $162.83 | 4,322 | 6 |
| Dundee, NY | $67.72 | $32.46 – $69.65 | 4,322 | 4 |
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.