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 |
|---|---|---|---|---|
| Dushore, PA | $62.07 | $62.07 – $62.07 | 3,530 | 1 |
| Halifax, PA | $39.16 | $0.00 – $53.88 | 3,530 | 4 |
| Universal City, CA | $0.06 | $0.01 – $0.12 | 3,528 | 2 |
| Shippenville, PA | $35.85 | $35.57 – $36.29 | 3,528 | 3 |
| Queenstown, MD | $78.50 | $2.81 – $120.03 | 3,527 | 11 |
| Canton, SD | $44.43 | $35.60 – $44.46 | 3,525 | 2 |
| Na'Alehu, HI | $167.99 | $143.96 – $191.67 | 3,525 | 2 |
| Pawling, NY | $116.45 | $111.62 – $124.18 | 3,525 | 3 |
| Kenhorst, PA | $41.37 | $41.37 – $41.37 | 3,524 | 1 |
| Atkins, AR | $25.35 | $18.68 – $28.28 | 3,523 | 3 |
| Sumner, IA | $28.28 | $9.11 – $33.64 | 3,522 | 7 |
| Rangeley, ME | $5.57 | $1.88 – $56.34 | 3,521 | 2 |
| Roebuck, SC | $64.62 | $38.86 – $64.98 | 3,520 | 2 |
| Williston, SC | $129.32 | $118.81 – $134.11 | 3,519 | 3 |
| Dozier, AL | $0.00 | $0.00 – $0.00 | 3,516 | 1 |
| Social Circle, GA | $57.96 | $26.50 – $58.51 | 3,515 | 2 |
| Westville, IN | $36.38 | $34.24 – $63.23 | 3,515 | 3 |
| Lampasas, TX | $33.11 | $0.00 – $298.94 | 3,512 | 5 |
| Fort Myers Beach, FL | $54.53 | $42.12 – $78.40 | 3,510 | 3 |
| Shell Knob, MO | $78.20 | $50.97 – $110.11 | 3,510 | 6 |
| Downsville, LA | $0.02 | $0.02 – $0.02 | 3,510 | 1 |
| Twentynine Palms, CA | $40.76 | $0.00 – $108.48 | 3,508 | 10 |
| Okarche, OK | $83.27 | $76.39 – $90.98 | 3,505 | 2 |
| Dieterich, IL | $0.00 | $0.00 – $0.00 | 3,504 | 2 |
| Tuttle, OK | $99.79 | $76.91 – $115.31 | 3,503 | 5 |
| Bicknell, IN | $39.56 | $39.29 – $62.34 | 3,502 | 2 |
| Charlestown, RI | $153.17 | $0.00 – $297.26 | 3,502 | 8 |
| Ft Mcpherson, GA | $47.54 | $47.54 – $47.54 | 3,501 | 1 |
| Tuntutuliak, AK | $340.19 | $6.89 – $471.07 | 3,499 | 3 |
| Anton Chico, NM | $139.54 | $139.54 – $139.54 | 3,493 | 1 |
| Mountain Village, AK | $206.80 | $0.00 – $430.90 | 3,492 | 4 |
| Robinsonville, MS | $40.32 | $35.56 – $69.27 | 3,485 | 3 |
| Hensonville, NY | $82.36 | $71.68 – $89.83 | 3,485 | 2 |
| Fort Yukon, AK | $422.38 | $32.21 – $733.37 | 3,482 | 3 |
| N Caldwell, NJ | $37.48 | $37.48 – $37.48 | 3,482 | 1 |
| Monette, AR | $33.09 | $33.09 – $33.09 | 3,482 | 1 |
| Dudley, MA | $44.47 | $25.37 – $51.77 | 3,478 | 3 |
| Ojo Encino, NM | $149.68 | $149.68 – $149.68 | 3,477 | 1 |
| Mendocino, CA | $1.24 | $0.00 – $46.97 | 3,475 | 3 |
| New Cuyama, CA | $122.48 | $122.48 – $122.48 | 3,475 | 1 |
| Bee Cave, TX | $42.87 | $13.43 – $180.08 | 3,474 | 7 |
| Richland, MI | $48.33 | $42.84 – $56.58 | 3,467 | 4 |
| Lena, IL | $54.42 | $36.87 – $62.30 | 3,467 | 5 |
| Terra Alta, WV | $47.90 | $47.90 – $47.90 | 3,463 | 1 |
| Tamc, HI | $51.62 | $1.22 – $70.86 | 3,462 | 4 |
| Northome, MN | $60.26 | $60.26 – $60.26 | 3,461 | 1 |
| Altavista, VA | $53.83 | $32.71 – $70.84 | 3,459 | 4 |
| Alger, MI | $36.35 | $30.91 – $44.83 | 3,459 | 2 |
| Dubois, WY | $11.38 | $0.00 – $61.26 | 3,459 | 4 |
| Grand Island, NY | $43.72 | $1.67 – $68.05 | 3,456 | 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.