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 |
|---|---|---|---|---|
| Castalia, OH | $46.74 | $46.13 – $48.57 | 2,663 | 2 |
| Gallatin, MO | $50.73 | $16.68 – $71.22 | 2,662 | 3 |
| Newton, AL | $1.36 | $0.00 – $22.53 | 2,659 | 3 |
| Rifton, NY | $61.09 | $58.12 – $70.85 | 2,659 | 3 |
| Free Union, VA | $58.34 | $58.34 – $58.34 | 2,656 | 1 |
| Dolores, CO | $167.85 | $90.11 – $197.24 | 2,655 | 4 |
| Maysville, GA | $51.13 | $0.00 – $51.83 | 2,655 | 2 |
| W Burlington, IA | $34.10 | $34.10 – $34.10 | 2,654 | 1 |
| Tuscola, TX | $73.32 | $0.00 – $76.51 | 2,652 | 3 |
| Lake Balboa, CA | $31.98 | $14.52 – $74.67 | 2,651 | 3 |
| Murfreesboro, NC | $32.99 | $32.99 – $32.99 | 2,647 | 1 |
| Jefferson Cty, MO | $56.84 | $56.84 – $56.84 | 2,644 | 1 |
| Fort Bliss, TX | $51.13 | $0.53 – $84.54 | 2,643 | 6 |
| Tribune, KS | $138.76 | $21.55 – $148.26 | 2,639 | 2 |
| Minong, WI | $28.45 | $21.16 – $35.14 | 2,639 | 4 |
| Hot Springs, VA | $50.47 | $32.83 – $78.33 | 2,638 | 6 |
| Tupper Lake, NY | $66.59 | $21.76 – $73.59 | 2,636 | 6 |
| Vass, NC | $48.33 | $44.19 – $57.39 | 2,635 | 3 |
| Bassfield, MS | $25.76 | $15.76 – $37.22 | 2,635 | 2 |
| Centralia, MO | $67.87 | $53.13 – $137.05 | 2,634 | 5 |
| Middleton, MA | $38.60 | $2.04 – $79.56 | 2,631 | 6 |
| Oakdale, PA | $31.11 | $24.55 – $45.83 | 2,630 | 4 |
| Summerton, SC | $53.05 | $52.78 – $59.43 | 2,629 | 2 |
| Hope, RI | $48.52 | $48.52 – $48.52 | 2,629 | 1 |
| Cedarville, CA | $1.51 | $1.51 – $1.51 | 2,628 | 1 |
| Napaskiak, AK | $279.85 | $126.22 – $435.20 | 2,628 | 3 |
| Del Valle, TX | $34.22 | $34.07 – $45.60 | 2,628 | 2 |
| Maricao, PR | $0.00 | $0.00 – $0.00 | 2,626 | 1 |
| Pt. Byron, NY | $68.76 | $68.76 – $68.76 | 2,624 | 1 |
| Eagleville, PA | $32.29 | $21.00 – $78.43 | 2,624 | 4 |
| Salem, CT | $56.08 | $0.00 – $56.53 | 2,623 | 2 |
| Carefree, AZ | $53.57 | $53.57 – $53.57 | 2,622 | 1 |
| Gnadenhutten, OH | $44.86 | $44.86 – $44.86 | 2,621 | 1 |
| Denver, PA | $44.36 | $44.36 – $44.36 | 2,618 | 1 |
| Granite Bay, CA | $14.69 | $1.44 – $16.79 | 2,616 | 3 |
| New Concord, OH | $51.66 | $45.37 – $128.90 | 2,613 | 3 |
| Blauvelt, NY | $112.09 | $46.55 – $117.88 | 2,612 | 2 |
| Monee, IL | $41.32 | $29.44 – $78.04 | 2,610 | 3 |
| Lena, MS | $23.63 | $16.18 – $23.79 | 2,609 | 2 |
| Buckingham, PA | $40.41 | $1.55 – $52.13 | 2,609 | 7 |
| Stratford, WI | $53.16 | $23.81 – $58.79 | 2,608 | 3 |
| Lockney, TX | $46.15 | $22.60 – $73.31 | 2,607 | 3 |
| Braymer, MO | $67.54 | $67.17 – $71.73 | 2,607 | 2 |
| Van Horn, TX | $85.99 | $32.34 – $95.60 | 2,607 | 2 |
| Shellsburg, IA | $0.44 | $0.00 – $0.49 | 2,606 | 3 |
| Homestead, PA | $8.58 | $0.00 – $31.10 | 2,605 | 7 |
| Fairview, PA | $46.18 | $43.28 – $57.56 | 2,604 | 4 |
| Cambridge, NE | $109.12 | $15.59 – $152.46 | 2,603 | 7 |
| Elbow Lake, MN | $56.44 | $49.86 – $61.98 | 2,602 | 3 |
| Federal Heights, CO | $51.09 | $51.09 – $51.09 | 2,601 | 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.