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 |
|---|---|---|---|---|
| Randolph Afb, TX | $80.01 | $32.20 – $82.20 | 3,689 | 3 |
| Flossmore, IN | $50.95 | $50.95 – $50.95 | 3,689 | 1 |
| East Greenbush, NY | $54.79 | $49.47 – $60.55 | 3,687 | 2 |
| Smethport, PA | $2.79 | $0.05 – $40.44 | 3,686 | 4 |
| Tununak, AK | $25.57 | $0.00 – $149.39 | 3,685 | 3 |
| Buchanan, GA | $19.92 | $19.53 – $24.49 | 3,684 | 2 |
| Hydro, OK | $79.96 | $64.47 – $97.24 | 3,682 | 2 |
| Lake Barrington, IL | $50.09 | $11.97 – $74.73 | 3,682 | 17 |
| Lisbon, ND | $68.10 | $44.09 – $144.85 | 3,676 | 8 |
| Mt Sinai, NY | $76.14 | $76.14 – $76.14 | 3,675 | 1 |
| Naples, ME | $57.92 | $31.80 – $62.24 | 3,675 | 2 |
| West Park, FL | $41.66 | $41.66 – $41.66 | 3,674 | 1 |
| Alamo, GA | $105.72 | $105.72 – $105.72 | 3,672 | 1 |
| North Bennington, VT | $26.54 | $20.92 – $53.89 | 3,672 | 2 |
| Avon, NC | $61.84 | $54.80 – $62.60 | 3,671 | 2 |
| Nahunta, GA | $42.50 | $30.60 – $50.64 | 3,670 | 3 |
| Bylas, AZ | $95.79 | $95.79 – $95.79 | 3,670 | 1 |
| Amston, CT | $90.83 | $90.83 – $90.83 | 3,669 | 1 |
| Rehoboth, MA | $43.29 | $38.31 – $54.79 | 3,668 | 5 |
| Bypro, KY | $32.91 | $32.91 – $32.91 | 3,665 | 1 |
| Lake Elmo, MN | $97.36 | $51.86 – $127.27 | 3,665 | 7 |
| Fairfield, NJ | $76.69 | $49.22 – $97.72 | 3,665 | 4 |
| Eleele, HI | $26.21 | $13.10 – $39.95 | 3,664 | 3 |
| Eek, AK | $246.19 | $164.60 – $432.52 | 3,664 | 3 |
| Renville, MN | $168.83 | $26.87 – $231.21 | 3,663 | 3 |
| Carbondale, CO | $71.85 | $59.95 – $77.63 | 3,661 | 10 |
| Glenside, PA | $34.05 | $17.33 – $107.51 | 3,659 | 10 |
| Folsom, PA | $19.48 | $12.32 – $32.48 | 3,653 | 5 |
| Laporte, CO | $62.65 | $61.65 – $67.17 | 3,653 | 2 |
| Bowmansville, NY | $46.73 | $43.82 – $48.34 | 3,651 | 3 |
| Fort Recovery, OH | $51.17 | $29.27 – $53.34 | 3,651 | 4 |
| Lopez Island, WA | $54.29 | $52.39 – $62.18 | 3,649 | 3 |
| Mason City, IL | $11.53 | $0.32 – $62.43 | 3,647 | 2 |
| Ainsworth, NE | $70.23 | $16.54 – $126.34 | 3,644 | 8 |
| Manteo, NC | $58.75 | $17.71 – $98.01 | 3,639 | 8 |
| Arnold, CA | $26.65 | $25.17 – $32.56 | 3,638 | 3 |
| Ravenna, MI | $65.29 | $65.28 – $65.30 | 3,636 | 2 |
| St Albans, NY | $59.70 | $59.70 – $59.70 | 3,635 | 1 |
| E Syracuse, NY | $52.79 | $41.16 – $63.59 | 3,634 | 4 |
| Lindsborg, KS | $87.63 | $11.56 – $683.10 | 3,633 | 7 |
| Wesley Hills, NY | $79.80 | $79.80 – $79.80 | 3,631 | 1 |
| Lakeland, GA | $51.08 | $51.08 – $51.08 | 3,631 | 1 |
| Carbondale, KS | $54.27 | $30.37 – $96.37 | 3,631 | 6 |
| Cherry Point, NC | $57.77 | $0.80 – $62.58 | 3,630 | 5 |
| St. Martinville, LA | $29.07 | $0.00 – $30.81 | 3,627 | 2 |
| Tamworth, NH | $45.41 | $45.41 – $45.41 | 3,625 | 1 |
| Ronda, NC | $29.68 | $23.85 – $43.66 | 3,625 | 4 |
| Oasis, ID | $53.22 | $53.22 – $53.22 | 3,623 | 1 |
| Randle, WA | $36.83 | $5.37 – $54.93 | 3,620 | 4 |
| Vandalia, MO | $71.75 | $33.38 – $88.85 | 3,619 | 2 |
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.