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 |
|---|---|---|---|---|
| Sparrows Point, MD | $94.79 | $12.27 – $95.72 | 2,601 | 2 |
| Somerville, OH | $61.06 | $61.06 – $61.06 | 2,600 | 1 |
| Togiak, AK | $303.57 | $121.28 – $352.59 | 2,600 | 4 |
| Fate, TX | $50.61 | $45.88 – $51.03 | 2,598 | 2 |
| Pocono Summit, PA | $58.52 | $27.20 – $91.84 | 2,597 | 4 |
| Callaway, MD | $64.78 | $64.78 – $64.78 | 2,596 | 1 |
| N White Plains, NY | $101.88 | $101.88 – $101.88 | 2,595 | 1 |
| Thaxton, MS | $64.38 | $1.33 – $88.82 | 2,593 | 5 |
| Walnutport, PA | $40.01 | $3.99 – $42.60 | 2,593 | 2 |
| Berlin, PA | $22.31 | $7.67 – $40.98 | 2,589 | 3 |
| Wyndmoor, PA | $33.05 | $0.00 – $62.01 | 2,589 | 6 |
| Pembroke, NH | $40.91 | $37.78 – $50.55 | 2,588 | 7 |
| Hampton, IL | $43.29 | $43.29 – $43.29 | 2,586 | 1 |
| Steep Falls, ME | $49.75 | $49.75 – $49.75 | 2,585 | 1 |
| Coto Laurel Pr, PR | $35.10 | $35.10 – $35.10 | 2,584 | 1 |
| Newell, WV | $37.37 | $35.57 – $41.92 | 2,584 | 2 |
| Elkhart, KS | $234.30 | $25.58 – $236.59 | 2,581 | 2 |
| Spencer, TN | $32.27 | $31.86 – $33.13 | 2,576 | 2 |
| Berryville, VA | $52.69 | $15.55 – $70.00 | 2,576 | 6 |
| Fort White, FL | $33.85 | $33.85 – $33.85 | 2,575 | 1 |
| Philadelphia, NY | $67.70 | $67.70 – $67.70 | 2,574 | 1 |
| Melcher, IA | $26.84 | $26.84 – $26.84 | 2,574 | 1 |
| Yates Center, KS | $32.16 | $5.36 – $123.77 | 2,573 | 3 |
| Big Timber, MT | $0.65 | $0.00 – $103.97 | 2,569 | 2 |
| Wellington, CO | $63.97 | $63.87 – $69.30 | 2,569 | 2 |
| Kenneth City, FL | $26.98 | $3.61 – $56.83 | 2,569 | 4 |
| Attica, IN | $56.11 | $47.82 – $79.12 | 2,568 | 2 |
| Palo Cedro, CA | $5.10 | $2.71 – $5.18 | 2,566 | 2 |
| Glennville, GA | $52.30 | $0.00 – $52.82 | 2,564 | 2 |
| Greenvale, NY | $88.80 | $35.49 – $115.83 | 2,563 | 10 |
| Mojave, CA | $80.47 | $42.01 – $299.12 | 2,560 | 2 |
| W. Haverstraw, NY | $74.01 | $74.01 – $74.01 | 2,560 | 1 |
| So Charleston, WV | $38.47 | $37.32 – $87.99 | 2,558 | 2 |
| Pierceton, IN | $45.97 | $45.97 – $45.97 | 2,556 | 1 |
| Coaldale, PA | $44.99 | $38.37 – $70.82 | 2,554 | 2 |
| Nightmute, AK | $382.57 | $302.66 – $425.98 | 2,549 | 3 |
| Stovall, NC | $36.71 | $0.00 – $36.90 | 2,549 | 2 |
| Mount Vernon, TX | $0.00 | $0.00 – $0.00 | 2,548 | 1 |
| Platte, SD | $88.67 | $88.67 – $88.67 | 2,546 | 1 |
| Frankfort, KS | $68.65 | $47.13 – $131.85 | 2,543 | 2 |
| Weehawken, NJ | $47.38 | $22.49 – $50.55 | 2,536 | 3 |
| Arlington Hts, IL | $10.14 | $1.43 – $38.91 | 2,535 | 3 |
| Solon, IA | $40.86 | $19.16 – $47.22 | 2,534 | 2 |
| New London, MN | $62.18 | $58.97 – $89.82 | 2,533 | 6 |
| Mt Vernon, TX | $51.54 | $41.46 – $74.07 | 2,533 | 2 |
| Budd Lake, NJ | $67.83 | $67.83 – $67.83 | 2,530 | 1 |
| Rosemont, IL | $88.46 | $48.20 – $332.02 | 2,530 | 6 |
| Stinnett, KY | $27.36 | $27.36 – $27.36 | 2,524 | 1 |
| Wheaton, MN | $87.72 | $23.76 – $93.65 | 2,523 | 5 |
| Bennington, NE | $68.73 | $68.73 – $68.73 | 2,520 | 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.