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 |
|---|---|---|---|---|
| Mendham, NJ | $35.25 | $35.25 – $35.25 | 3,612 | 1 |
| Florence, WI | $29.30 | $9.63 – $36.51 | 3,610 | 5 |
| Wells, ME | $32.38 | $16.87 – $59.17 | 3,610 | 7 |
| Dell Rapids, SD | $36.90 | $22.54 – $37.71 | 3,608 | 2 |
| Highmount, NY | $64.04 | $64.04 – $64.04 | 3,601 | 1 |
| Madison, NJ | $48.46 | $25.66 – $60.83 | 3,600 | 6 |
| Tyler, MN | $134.89 | $56.54 – $181.01 | 3,600 | 8 |
| Greenville, CA | $10.78 | $1.72 – $22.27 | 3,597 | 3 |
| South Hutchinson, KS | $86.80 | $86.80 – $86.80 | 3,597 | 1 |
| Madisonville, TX | $39.78 | $0.00 – $63.83 | 3,594 | 5 |
| Ringwood, NJ | $47.53 | $44.44 – $55.50 | 3,593 | 2 |
| Ponderay, ID | $53.20 | $43.44 – $75.58 | 3,591 | 5 |
| Harlingent, TX | $48.45 | $48.45 – $48.45 | 3,590 | 1 |
| Edgard, LA | $0.07 | $0.00 – $0.07 | 3,589 | 2 |
| Sandy Lake, PA | $0.11 | $0.00 – $0.15 | 3,588 | 2 |
| Kings Mtn, NC | $68.69 | $68.69 – $68.69 | 3,586 | 1 |
| Granville, IL | $51.94 | $46.07 – $57.71 | 3,586 | 3 |
| Waynoka, OK | $82.90 | $75.99 – $99.76 | 3,585 | 2 |
| Millbrae, CA | $19.56 | $0.26 – $122.05 | 3,582 | 3 |
| Bondville, VT | $0.27 | $0.27 – $0.27 | 3,580 | 1 |
| Beaverton, AL | $47.98 | $47.98 – $47.98 | 3,580 | 1 |
| Woodside, CA | $40.10 | $0.00 – $40.25 | 3,579 | 3 |
| Lynx, OH | $32.12 | $32.12 – $32.12 | 3,578 | 1 |
| Jane Lew, WV | $77.13 | $40.59 – $89.81 | 3,577 | 6 |
| Maple Glen, PA | $43.96 | $43.96 – $43.96 | 3,575 | 1 |
| Cohasset, MA | $43.06 | $0.00 – $80.80 | 3,571 | 14 |
| Unalaska, AK | $454.19 | $55.14 – $620.36 | 3,569 | 5 |
| Hialeah Gardens, FL | $37.01 | $0.00 – $105.30 | 3,567 | 8 |
| Athens, WV | $5.98 | $0.00 – $28.94 | 3,567 | 5 |
| Groveland, CA | $38.30 | $34.51 – $60.73 | 3,567 | 2 |
| Grabill, IN | $54.88 | $40.23 – $73.78 | 3,567 | 4 |
| Lyndora, PA | $36.58 | $32.54 – $55.60 | 3,560 | 3 |
| Sante Fe, NM | $88.72 | $72.77 – $106.86 | 3,558 | 3 |
| N Easton, MA | $41.48 | $34.94 – $54.00 | 3,557 | 2 |
| Keyport, NJ | $16.77 | $0.29 – $18.66 | 3,554 | 2 |
| Drums, PA | $33.43 | $1.13 – $33.75 | 3,554 | 3 |
| Rowley, MA | $47.55 | $3.92 – $66.39 | 3,552 | 6 |
| Troutman, NC | $45.63 | $29.94 – $63.66 | 3,552 | 7 |
| City Of Commerce, CA | $421.63 | $421.63 – $421.63 | 3,551 | 1 |
| Lino Lakes, MN | $73.28 | $23.50 – $257.77 | 3,549 | 15 |
| Breckenridge, CO | $54.32 | $0.00 – $81.06 | 3,547 | 7 |
| Hampton, NJ | $61.40 | $0.00 – $80.45 | 3,542 | 8 |
| Allardt, TN | $37.99 | $37.99 – $37.99 | 3,539 | 1 |
| West View, PA | $50.09 | $46.84 – $52.65 | 3,537 | 2 |
| Hoodsport, WA | $55.28 | $45.74 – $87.03 | 3,536 | 3 |
| Union Mills, IN | $63.05 | $63.05 – $63.05 | 3,536 | 1 |
| Bolton, CT | $44.48 | $8.02 – $55.45 | 3,535 | 5 |
| Lemmon, SD | $85.96 | $85.96 – $85.96 | 3,535 | 1 |
| Merillville, IL | $28.01 | $28.01 – $28.01 | 3,535 | 1 |
| Walworth, WI | $34.75 | $19.88 – $55.83 | 3,534 | 5 |
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.