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 |
|---|---|---|---|---|
| Sanbornville, NH | $35.25 | $20.65 – $40.40 | 2,519 | 5 |
| De Soto, MO | $32.22 | $16.14 – $52.31 | 2,519 | 4 |
| Philipsburg, MT | $0.37 | $0.37 – $0.37 | 2,518 | 1 |
| Mayville, WI | $27.75 | $24.67 – $40.90 | 2,516 | 5 |
| Baldwin City, KS | $28.64 | $8.07 – $33.39 | 2,515 | 4 |
| Saegertown, PA | $9.62 | $0.00 – $36.07 | 2,515 | 3 |
| Freeland, PA | $39.26 | $0.00 – $46.68 | 2,514 | 2 |
| Old Westbury, NY | $36.05 | $28.57 – $65.74 | 2,514 | 5 |
| Shelter Island, NY | $147.75 | $147.60 – $152.19 | 2,512 | 2 |
| Deer Trail, CO | $77.59 | $77.59 – $77.59 | 2,511 | 1 |
| Washington, KS | $89.34 | $89.28 – $99.41 | 2,511 | 2 |
| Mosinee, WI | $27.22 | $22.99 – $42.24 | 2,510 | 4 |
| Waialua, HI | $13.20 | $13.20 – $13.20 | 2,509 | 1 |
| Reading, OH | $44.62 | $40.17 – $57.58 | 2,509 | 4 |
| Duanesburg, NY | $88.51 | $62.44 – $91.36 | 2,507 | 2 |
| Sinton, TX | $26.57 | $26.04 – $65.63 | 2,505 | 4 |
| Beloit, OH | $33.57 | $17.65 – $40.05 | 2,504 | 5 |
| Damascus, OH | $45.23 | $45.23 – $45.23 | 2,503 | 1 |
| Grass Lake, MI | $30.22 | $26.80 – $65.18 | 2,503 | 2 |
| Shelby, IA | $0.00 | $0.00 – $0.00 | 2,503 | 1 |
| Oceanport, NJ | $71.39 | $71.39 – $71.39 | 2,503 | 1 |
| New Washington, OH | $53.73 | $0.00 – $55.32 | 2,501 | 3 |
| Central City, IA | $54.46 | $54.46 – $54.46 | 2,498 | 1 |
| Weaver, AL | $72.44 | $72.44 – $72.44 | 2,496 | 1 |
| Millport, AL | $3.88 | $0.00 – $41.10 | 2,489 | 3 |
| Rollingwood, TX | $63.65 | $27.33 – $130.70 | 2,489 | 4 |
| Laplata, MD | $43.61 | $32.55 – $73.50 | 2,489 | 4 |
| Shenandoah, VA | $69.24 | $68.76 – $70.68 | 2,487 | 2 |
| Clifton, AZ | $0.00 | $0.00 – $0.00 | 2,485 | 1 |
| Egg Harbor, WI | $17.68 | $16.56 – $42.84 | 2,485 | 2 |
| Catlin, IL | $32.53 | $30.00 – $35.13 | 2,481 | 2 |
| Genoa, NE | $56.80 | $24.41 – $115.50 | 2,481 | 5 |
| Clearwater, KS | $163.01 | $23.09 – $163.97 | 2,481 | 2 |
| Junction, IL | $0.18 | $0.18 – $0.18 | 2,478 | 1 |
| S. Burlington, VT | $18.53 | $13.93 – $26.07 | 2,477 | 7 |
| Offutt Afb, NE | $93.70 | $14.28 – $142.64 | 2,475 | 11 |
| Cottage Grove, WI | $30.50 | $17.90 – $42.42 | 2,474 | 13 |
| Gouldsboro, ME | $24.80 | $21.42 – $28.17 | 2,471 | 4 |
| Indialantic, FL | $52.16 | $5.47 – $62.67 | 2,471 | 5 |
| Kalaheo, HI | $44.00 | $6.46 – $317.65 | 2,471 | 11 |
| Elroy, WI | $59.27 | $28.07 – $65.79 | 2,465 | 3 |
| Watertown, MN | $57.34 | $41.19 – $70.68 | 2,465 | 5 |
| Wyncote, PA | $3.14 | $0.00 – $49.08 | 2,465 | 5 |
| Oshkosh, NE | $91.90 | $18.56 – $95.45 | 2,464 | 3 |
| Red Fox, KY | $19.96 | $9.81 – $35.91 | 2,463 | 2 |
| Shoshone, ID | $1.62 | $0.85 – $2.32 | 2,461 | 2 |
| Tijeras, NM | $65.80 | $52.96 – $65.94 | 2,458 | 2 |
| Eatonton, GA | $52.42 | $0.00 – $124.64 | 2,457 | 10 |
| Darby, MT | $0.09 | $0.09 – $0.09 | 2,455 | 1 |
| Reedsville, PA | $38.21 | $32.82 – $42.05 | 2,453 | 4 |
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.