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 |
|---|---|---|---|---|
| New Houlka, MS | $19.68 | $19.68 – $19.68 | 2,729 | 1 |
| Beverly Farms, MA | $41.43 | $41.43 – $41.43 | 2,729 | 1 |
| Reinbeck, IA | $31.25 | $25.83 – $37.40 | 2,727 | 3 |
| Hilliard, FL | $24.03 | $20.09 – $25.25 | 2,722 | 3 |
| Milford, IN | $48.77 | $35.74 – $59.75 | 2,722 | 4 |
| Hemingway, SC | $124.97 | $124.97 – $124.97 | 2,722 | 1 |
| Alamo, CA | $37.59 | $0.12 – $68.26 | 2,720 | 4 |
| Lake Forest Park, WA | $45.82 | $38.69 – $57.48 | 2,719 | 8 |
| Canton, OK | $51.59 | $0.00 – $98.81 | 2,718 | 3 |
| Mount Sinai, NY | $82.72 | $13.42 – $119.48 | 2,717 | 8 |
| Elma, NY | $47.13 | $38.58 – $82.54 | 2,717 | 4 |
| North Salt Lake, UT | $140.17 | $54.22 – $202.91 | 2,716 | 2 |
| Seiling, OK | $73.99 | $72.83 – $151.73 | 2,715 | 2 |
| Holly, MI | $57.40 | $22.40 – $70.25 | 2,712 | 5 |
| The Bronx, NY | $46.34 | $44.09 – $68.95 | 2,711 | 2 |
| Youngwood, PA | $42.23 | $41.21 – $51.31 | 2,711 | 3 |
| Morris, AL | $73.44 | $73.44 – $73.44 | 2,709 | 1 |
| Reading, MI | $3.99 | $3.99 – $3.99 | 2,709 | 1 |
| Albertville, MN | $72.22 | $56.76 – $82.18 | 2,708 | 3 |
| Londonderry, VT | $0.96 | $0.00 – $12.78 | 2,707 | 4 |
| East Earl, PA | $51.58 | $45.10 – $55.01 | 2,705 | 3 |
| Bigfork, MT | $72.67 | $19.44 – $89.79 | 2,703 | 6 |
| Knob Noster, MO | $23.23 | $0.52 – $140.58 | 2,703 | 6 |
| Washington Township, OH | $47.00 | $17.45 – $75.67 | 2,695 | 3 |
| West Point, VA | $58.01 | $34.65 – $72.69 | 2,694 | 5 |
| Empire, MI | $16.99 | $11.32 – $41.81 | 2,694 | 4 |
| Bush, LA | $35.44 | $19.75 – $47.57 | 2,689 | 4 |
| Millbury, MA | $73.15 | $3.38 – $105.80 | 2,688 | 8 |
| Carlstadt, NJ | $20.77 | $20.77 – $20.77 | 2,688 | 1 |
| Dighton, KS | $120.70 | $109.39 – $120.87 | 2,688 | 2 |
| Bellevue, PA | $37.48 | $3.62 – $42.00 | 2,687 | 4 |
| Willington, CT | $89.21 | $89.21 – $89.21 | 2,687 | 1 |
| Trabuco Canyon, CA | $72.27 | $72.27 – $72.27 | 2,686 | 1 |
| Junction City, OH | $45.19 | $45.19 – $45.19 | 2,684 | 1 |
| N Potomac, MD | $91.19 | $91.19 – $91.19 | 2,683 | 1 |
| Brandon, SD | $18.51 | $3.62 – $54.46 | 2,683 | 2 |
| Hallock, MN | $82.58 | $54.22 – $87.45 | 2,683 | 3 |
| Portage, PA | $2.74 | $0.00 – $60.90 | 2,682 | 4 |
| Madena, CA | $6.18 | $6.18 – $6.18 | 2,682 | 1 |
| Lewisburg, OH | $43.52 | $43.52 – $43.52 | 2,681 | 1 |
| Noorvik, AK | $143.75 | $70.63 – $165.41 | 2,677 | 4 |
| 2500 Alhambra Avenue, CA | $0.00 | $0.00 – $0.00 | 2,677 | 1 |
| Mills River, NC | $38.20 | $26.73 – $82.85 | 2,677 | 6 |
| Guayaluca, PR | $41.00 | $41.00 – $41.00 | 2,677 | 1 |
| Red Jacket, WV | $58.79 | $58.79 – $58.79 | 2,677 | 1 |
| East Petersburg, PA | $44.03 | $29.94 – $47.40 | 2,675 | 3 |
| Meadow Bridge, WV | $8.68 | $0.01 – $31.89 | 2,673 | 3 |
| Cheswick, PA | $53.07 | $33.32 – $72.75 | 2,671 | 6 |
| Ft Mitchell, KY | $98.48 | $21.41 – $103.42 | 2,671 | 5 |
| Willis, TX | $38.37 | $0.00 – $125.86 | 2,665 | 10 |
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.