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 |
|---|---|---|---|---|
| Guffey, CO | $71.38 | $71.38 – $71.38 | 2,800 | 1 |
| Colquitt, GA | $20.16 | $8.11 – $31.36 | 2,797 | 3 |
| Florissant, CO | $65.15 | $65.15 – $65.15 | 2,795 | 1 |
| Creede, CO | $193.05 | $54.75 – $208.85 | 2,793 | 3 |
| Hartford, TN | $28.96 | $28.96 – $28.96 | 2,793 | 1 |
| Minersville, PA | $0.97 | $0.00 – $19.32 | 2,793 | 4 |
| Vale, OR | $10.62 | $0.86 – $28.00 | 2,792 | 4 |
| New Carrollton, MD | $103.42 | $9.07 – $145.53 | 2,791 | 5 |
| Arlington, MN | $80.95 | $54.16 – $84.52 | 2,789 | 5 |
| La Crescent, MN | $32.03 | $23.32 – $51.11 | 2,789 | 5 |
| Corte Madera, CA | $21.72 | $0.49 – $126.92 | 2,786 | 7 |
| Brimfield, MA | $36.18 | $13.52 – $98.85 | 2,786 | 5 |
| Oglesby, IL | $6.55 | $0.00 – $63.94 | 2,784 | 4 |
| Bloomfiled, CT | $63.89 | $63.89 – $63.89 | 2,781 | 1 |
| Skokomish Nation, WA | $50.65 | $47.08 – $53.46 | 2,780 | 2 |
| Comfort, TX | $36.25 | $35.94 – $90.15 | 2,777 | 2 |
| Marshall, AR | $25.52 | $13.35 – $49.91 | 2,777 | 8 |
| Nuremberg, PA | $0.00 | $0.00 – $0.00 | 2,775 | 2 |
| Ft. Payne, AL | $201.61 | $201.61 – $201.61 | 2,772 | 1 |
| Elkton, MI | $13.94 | $8.04 – $19.27 | 2,768 | 2 |
| Pineurst, NC | $44.94 | $44.94 – $44.94 | 2,768 | 1 |
| Exira, IA | $0.17 | $0.17 – $0.17 | 2,765 | 1 |
| West Boylston, MA | $68.20 | $43.69 – $101.55 | 2,765 | 9 |
| Bethany Beach, DE | $58.30 | $5.50 – $66.30 | 2,764 | 2 |
| Landing, NJ | $22.24 | $10.95 – $42.90 | 2,762 | 4 |
| Sultan, WA | $47.82 | $41.74 – $60.64 | 2,762 | 4 |
| Crewe, VA | $45.72 | $39.80 – $64.23 | 2,761 | 2 |
| Lindale, GA | $78.53 | $78.53 – $78.53 | 2,761 | 1 |
| Lou, KY | $55.80 | $54.44 – $56.46 | 2,760 | 2 |
| Bunn, NC | $37.80 | $37.80 – $37.80 | 2,760 | 1 |
| Coarsegold, CA | $0.81 | $0.24 – $5.43 | 2,759 | 2 |
| Faulkton, SD | $82.74 | $82.74 – $82.74 | 2,758 | 1 |
| North English, IA | $0.10 | $0.00 – $0.10 | 2,758 | 2 |
| Jonesboro, IL | $43.77 | $43.77 – $43.77 | 2,757 | 1 |
| Greenfield, IL | $0.05 | $0.05 – $0.05 | 2,755 | 1 |
| Linchburg, VA | $55.81 | $55.81 – $55.81 | 2,752 | 1 |
| Irrigon, OR | $14.02 | $11.00 – $72.79 | 2,750 | 4 |
| Nassau Bay, TX | $36.58 | $36.58 – $36.58 | 2,750 | 1 |
| Pioneer, CA | $0.85 | $0.85 – $0.85 | 2,750 | 1 |
| Boones Mill, VA | $67.95 | $17.97 – $72.48 | 2,744 | 5 |
| Glenwood, AL | $28.79 | $28.79 – $28.79 | 2,743 | 1 |
| Clifton, VA | $86.05 | $86.05 – $86.05 | 2,742 | 1 |
| Apalachin, NY | $55.04 | $52.80 – $83.72 | 2,742 | 4 |
| Patuxent River, MD | $106.64 | $83.25 – $111.91 | 2,742 | 4 |
| Buena, NJ | $9.65 | $6.02 – $39.53 | 2,739 | 4 |
| Slinger, WI | $36.31 | $20.38 – $53.48 | 2,739 | 8 |
| Weeki Wachee, FL | $39.46 | $4.18 – $51.09 | 2,737 | 8 |
| Big Sandy, MT | $0.00 | $0.00 – $0.00 | 2,732 | 2 |
| Robins Afb, GA | $199.00 | $21.39 – $330.46 | 2,732 | 5 |
| W Long Branch, NJ | $25.63 | $25.63 – $25.63 | 2,730 | 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.