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 |
|---|---|---|---|---|
| Blowing Rock, NC | $25.92 | $16.54 – $36.69 | 3,285 | 4 |
| Churchville, VA | $58.54 | $16.24 – $59.61 | 3,285 | 2 |
| Maben, MS | $37.56 | $0.00 – $140.72 | 3,284 | 4 |
| Stevens, PA | $55.80 | $50.71 – $343.51 | 3,283 | 2 |
| Shoreham, VT | $3.87 | $2.08 – $4.03 | 3,281 | 2 |
| Lafayette Hill, PA | $22.50 | $8.26 – $778.22 | 3,279 | 5 |
| Amado, AZ | $0.02 | $0.02 – $0.02 | 3,279 | 1 |
| Chester, VT | $2.89 | $2.85 – $3.72 | 3,279 | 2 |
| Allegany, NY | $62.80 | $49.66 – $68.18 | 3,276 | 4 |
| Newville, PA | $40.91 | $38.87 – $53.02 | 3,276 | 5 |
| Daggett, MI | $32.06 | $31.10 – $32.07 | 3,272 | 2 |
| Joelton, TN | $27.47 | $24.26 – $62.03 | 3,271 | 2 |
| Nebo, KY | $38.19 | $38.19 – $38.19 | 3,265 | 1 |
| Clarksburg, PA | $7.86 | $0.31 – $57.15 | 3,265 | 2 |
| Shoreham, NY | $88.91 | $56.62 – $96.09 | 3,258 | 5 |
| Saxonburg, PA | $37.20 | $0.00 – $51.36 | 3,256 | 4 |
| Hermosa Beach, CA | $157.34 | $0.00 – $172.97 | 3,254 | 5 |
| Avon By The Sea, NJ | $58.38 | $51.62 – $91.51 | 3,252 | 4 |
| Averill Park, NY | $55.13 | $48.97 – $56.90 | 3,252 | 3 |
| Boiling Springs, PA | $54.17 | $40.17 – $62.15 | 3,251 | 3 |
| Ayden, NC | $46.22 | $41.05 – $52.53 | 3,247 | 5 |
| Gosnell, AR | $5.58 | $5.58 – $5.58 | 3,246 | 1 |
| Tokeland, WA | $54.25 | $0.00 – $56.81 | 3,246 | 2 |
| Salina, UT | $63.94 | $57.22 – $76.41 | 3,242 | 4 |
| Chelsea, AL | $68.70 | $59.40 – $93.81 | 3,241 | 5 |
| Hartville, MO | $19.66 | $19.66 – $19.66 | 3,241 | 1 |
| Marshfield, ME | $36.70 | $36.70 – $36.70 | 3,241 | 1 |
| Washington Ch, OH | $42.23 | $23.59 – $52.29 | 3,239 | 3 |
| Sylvester, GA | $31.84 | $15.64 – $33.67 | 3,239 | 3 |
| Winnetka, IL | $91.38 | $37.74 – $108.93 | 3,237 | 5 |
| Fairview, NJ | $29.34 | $29.34 – $29.34 | 3,237 | 1 |
| Fairfield, PA | $55.23 | $34.11 – $57.06 | 3,235 | 3 |
| Delmar, MD | $59.68 | $14.88 – $61.70 | 3,235 | 3 |
| Talent, OR | $67.43 | $2.76 – $89.30 | 3,232 | 9 |
| Avella, PA | $26.48 | $26.48 – $26.48 | 3,232 | 1 |
| Pilot Mountain, NC | $57.75 | $49.78 – $64.32 | 3,230 | 6 |
| Hazen, ND | $161.35 | $111.33 – $245.04 | 3,230 | 5 |
| Ada, MN | $106.33 | $87.29 – $119.48 | 3,228 | 4 |
| Hamburg, MI | $70.41 | $70.41 – $70.41 | 3,227 | 1 |
| Franktown, VA | $48.24 | $47.68 – $58.29 | 3,226 | 2 |
| Childress, TX | $25.10 | $13.52 – $59.88 | 3,225 | 4 |
| Golbert, AZ | $46.30 | $46.30 – $46.30 | 3,224 | 1 |
| Valley City, OH | $38.36 | $17.66 – $49.07 | 3,222 | 4 |
| West Sayville, NY | $76.67 | $35.54 – $110.77 | 3,220 | 5 |
| Vanleer, TN | $43.39 | $43.39 – $43.39 | 3,219 | 1 |
| St John, IN | $63.90 | $34.00 – $71.77 | 3,219 | 6 |
| Garden Valley, ID | $61.98 | $56.86 – $64.99 | 3,219 | 3 |
| Orwell, OH | $41.45 | $32.25 – $48.07 | 3,219 | 3 |
| Nespelem, WA | $42.78 | $0.68 – $48.23 | 3,218 | 4 |
| Ulster Park, NY | $55.36 | $53.54 – $57.29 | 3,214 | 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.