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 |
|---|---|---|---|---|
| Charleston, MA | $33.02 | $33.02 – $33.02 | 2,387 | 1 |
| Castile, NY | $65.38 | $64.88 – $68.89 | 2,386 | 2 |
| Pinehill, NM | $46.74 | $25.39 – $63.13 | 2,385 | 2 |
| Roch, NY | $76.54 | $76.54 – $76.54 | 2,385 | 1 |
| Morgan, UT | $71.68 | $14.73 – $79.21 | 2,384 | 4 |
| Tripoli, IA | $23.13 | $22.84 – $24.82 | 2,383 | 2 |
| Akron, CO | $185.76 | $88.71 – $255.45 | 2,382 | 4 |
| Ocracoke, NC | $54.99 | $27.29 – $55.21 | 2,382 | 2 |
| Damascus, VA | $39.03 | $34.06 – $86.91 | 2,380 | 2 |
| Courtland, VA | $46.73 | $15.30 – $60.83 | 2,379 | 4 |
| Rockcave, WV | $0.87 | $0.00 – $0.98 | 2,378 | 2 |
| Derwood, MD | $91.32 | $41.27 – $91.66 | 2,378 | 2 |
| Panguitch, UT | $74.99 | $10.34 – $98.15 | 2,376 | 7 |
| Kronenwetter, WI | $30.31 | $22.52 – $40.92 | 2,372 | 3 |
| Norwich, OH | $43.60 | $43.60 – $43.60 | 2,371 | 1 |
| Mc Donald, PA | $42.04 | $40.78 – $43.61 | 2,371 | 3 |
| Waldwick, NJ | $53.74 | $5.57 – $83.43 | 2,370 | 9 |
| Broadlands, VA | $51.48 | $50.65 – $68.92 | 2,364 | 3 |
| Ambst, NY | $38.91 | $38.91 – $38.91 | 2,358 | 1 |
| Robert, LA | $6.28 | $6.28 – $6.28 | 2,354 | 1 |
| Cedarville, OH | $62.84 | $38.27 – $65.17 | 2,352 | 2 |
| Rupert, WV | $79.44 | $79.44 – $79.44 | 2,350 | 1 |
| Glennallen, AK | $323.19 | $116.32 – $582.07 | 2,348 | 3 |
| Berwyn, PA | $60.89 | $35.73 – $94.39 | 2,346 | 11 |
| Cropseyville, NY | $56.73 | $54.42 – $57.99 | 2,344 | 2 |
| Virden, IL | $3.25 | $3.25 – $3.25 | 2,343 | 1 |
| E. Los Angeles, CA | $6.45 | $5.67 – $10.68 | 2,342 | 2 |
| Baudette, MN | $65.65 | $26.85 – $70.65 | 2,333 | 4 |
| Long Valley, NJ | $70.60 | $70.55 – $71.32 | 2,333 | 2 |
| Mcgregor, MN | $145.56 | $145.56 – $145.56 | 2,333 | 1 |
| Basehor, KS | $35.08 | $26.33 – $40.42 | 2,331 | 3 |
| Llano, TX | $67.55 | $7.63 – $71.06 | 2,330 | 4 |
| Whiting, VT | $46.16 | $4.72 – $50.18 | 2,329 | 2 |
| Riverton, WV | $20.54 | $20.54 – $20.54 | 2,329 | 1 |
| Downieville, CA | $10.86 | $9.17 – $12.51 | 2,329 | 2 |
| Hurlock, MD | $37.63 | $23.47 – $37.93 | 2,327 | 2 |
| Hamburg, AR | $70.64 | $35.10 – $72.62 | 2,326 | 2 |
| Port Ewen, NY | $76.31 | $76.31 – $76.31 | 2,325 | 1 |
| San Felipe, NM | $353.14 | $15.73 – $485.07 | 2,323 | 2 |
| Stromsburg, NE | $64.27 | $58.30 – $68.14 | 2,322 | 2 |
| Universal City, TX | $44.30 | $33.04 – $53.79 | 2,321 | 3 |
| Rogersville, PA | $45.74 | $0.17 – $63.02 | 2,321 | 2 |
| Hemphill, TX | $31.61 | $28.83 – $37.21 | 2,319 | 2 |
| Cotuit, MA | $24.16 | $7.78 – $50.26 | 2,319 | 4 |
| Bay, AR | $30.61 | $5.82 – $33.46 | 2,318 | 3 |
| Tioga, ND | $72.55 | $56.87 – $179.58 | 2,318 | 8 |
| Lewiston Me, ME | $47.25 | $47.25 – $47.25 | 2,318 | 1 |
| Alpha, IL | $61.59 | $61.59 – $61.59 | 2,317 | 1 |
| Quantico, VA | $39.83 | $6.62 – $129.88 | 2,312 | 4 |
| Panville, KY | $28.13 | $28.13 – $28.13 | 2,312 | 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.