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 |
|---|---|---|---|---|
| Town And Country, MO | $68.23 | $58.81 – $119.88 | 4,114 | 4 |
| Conyngham,, OR | $31.55 | $31.55 – $31.55 | 4,112 | 1 |
| Sharonville, OH | $51.17 | $33.40 – $62.27 | 4,112 | 6 |
| Frederic, WI | $50.91 | $48.73 – $56.23 | 4,110 | 2 |
| Shavano Park, TX | $28.82 | $6.39 – $76.51 | 4,108 | 7 |
| Decaturville, TN | $29.78 | $28.97 – $32.45 | 4,107 | 2 |
| Daniel Island, SC | $65.38 | $43.16 – $73.51 | 4,104 | 7 |
| Center Point, LA | $32.97 | $32.60 – $33.70 | 4,100 | 2 |
| Lee, NH | $61.08 | $31.25 – $76.22 | 4,099 | 7 |
| Haleiwa, HI | $95.62 | $12.75 – $286.14 | 4,096 | 9 |
| Massapequa Park, NY | $113.68 | $52.60 – $220.21 | 4,095 | 8 |
| Armonk, NY | $109.84 | $32.78 – $145.19 | 4,093 | 10 |
| Oregon, WI | $42.90 | $10.71 – $73.09 | 4,093 | 17 |
| Portola, CA | $21.01 | $4.40 – $23.26 | 4,089 | 4 |
| Dahlonega, GA | $66.23 | $25.62 – $157.89 | 4,088 | 10 |
| Conifer, CO | $81.93 | $77.85 – $88.98 | 4,088 | 3 |
| Barton, VT | $15.73 | $8.03 – $19.41 | 4,084 | 2 |
| Chippewa Fls, WI | $52.18 | $31.99 – $57.50 | 4,079 | 4 |
| Pahala, HI | $68.52 | $63.93 – $76.93 | 4,076 | 2 |
| Williamsburg, MA | $49.50 | $47.96 – $58.94 | 4,073 | 3 |
| Pigeon Forge, TN | $29.56 | $22.01 – $35.38 | 4,072 | 6 |
| Centrailia, IL | $49.96 | $49.96 – $49.96 | 4,070 | 1 |
| Ferdinand, IN | $58.83 | $58.16 – $59.06 | 4,069 | 2 |
| Clayton, OK | $72.41 | $12.50 – $86.99 | 4,069 | 4 |
| Clintonville, WI | $47.25 | $25.74 – $78.70 | 4,067 | 8 |
| Tonkawa, OK | $123.02 | $64.26 – $131.94 | 4,067 | 2 |
| Del Mar, CA | $41.30 | $0.00 – $141.01 | 4,067 | 10 |
| Drasco, AR | $24.82 | $10.44 – $24.88 | 4,066 | 2 |
| Tecumseh, NE | $101.25 | $98.30 – $123.14 | 4,066 | 5 |
| Mccaysville, GA | $30.53 | $30.53 – $30.53 | 4,064 | 1 |
| Clifton, CO | $59.62 | $54.61 – $71.23 | 4,064 | 2 |
| Junction City, AR | $27.17 | $27.17 – $27.17 | 4,064 | 1 |
| Luther, OK | $78.68 | $78.68 – $78.68 | 4,062 | 1 |
| North Fork, CA | $1.76 | $0.00 – $7.98 | 4,062 | 3 |
| Yorktown Hts, NY | $124.63 | $48.55 – $216.49 | 4,061 | 5 |
| Viborg, SD | $77.16 | $58.45 – $81.07 | 4,058 | 2 |
| Bloomingdale, IN | $55.81 | $55.81 – $55.81 | 4,058 | 1 |
| Hinesburg, VT | $20.85 | $12.45 – $30.06 | 4,057 | 6 |
| Moroni, UT | $54.40 | $50.77 – $70.96 | 4,056 | 2 |
| Moraga, CA | $10.30 | $4.55 – $10.53 | 4,052 | 2 |
| Paxton, MA | $55.34 | $49.99 – $71.00 | 4,049 | 2 |
| Windsor, NC | $48.87 | $0.00 – $64.74 | 4,047 | 9 |
| La Vernia, TX | $87.94 | $21.43 – $260.00 | 4,043 | 8 |
| Paincourtville, LA | $27.21 | $12.08 – $32.72 | 4,043 | 3 |
| Durant, MS | $21.99 | $15.92 – $51.17 | 4,041 | 3 |
| Lively, VA | $33.81 | $14.70 – $46.85 | 4,039 | 3 |
| Orangevale, CA | $7.86 | $1.22 – $36.83 | 4,038 | 4 |
| Culbertson, MT | $0.00 | $0.00 – $0.00 | 4,037 | 2 |
| Metlakatla, AK | $248.99 | $10.30 – $446.41 | 4,036 | 4 |
| Gobles, MI | $1.16 | $1.16 – $1.16 | 4,036 | 1 |
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.