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 |
|---|---|---|---|---|
| Sierra, AZ | $48.28 | $48.28 – $48.28 | 2,249 | 1 |
| Howard City, MI | $11.07 | $11.07 – $11.07 | 2,247 | 1 |
| Fair Haven, NJ | $55.30 | $55.30 – $55.30 | 2,246 | 1 |
| Lake Lure, NC | $17.89 | $3.46 – $27.70 | 2,245 | 4 |
| Magnolia, OH | $23.72 | $19.19 – $23.77 | 2,243 | 2 |
| Wiley, CO | $57.85 | $57.85 – $57.85 | 2,243 | 1 |
| North Rlington, NJ | $63.64 | $63.64 – $63.64 | 2,241 | 1 |
| Westminister, CA | $59.49 | $59.49 – $59.49 | 2,235 | 1 |
| Byron, MN | $54.70 | $45.02 – $81.10 | 2,233 | 6 |
| Theodore, AL | $55.73 | $55.73 – $55.73 | 2,233 | 1 |
| Howard, SD | $154.80 | $116.19 – $159.14 | 2,230 | 2 |
| Edgeley, ND | $80.99 | $80.99 – $80.99 | 2,230 | 1 |
| Morrisville, PA | $41.68 | $5.25 – $73.00 | 2,228 | 7 |
| Pierz, MN | $94.02 | $50.05 – $272.70 | 2,227 | 5 |
| Whitmore Lake, MI | $59.95 | $59.95 – $59.95 | 2,226 | 1 |
| Mendota Heights, MN | $93.83 | $63.29 – $99.80 | 2,224 | 2 |
| Wickliffe, KY | $17.18 | $17.18 – $17.18 | 2,224 | 1 |
| Satanta, KS | $90.93 | $0.00 – $116.91 | 2,223 | 2 |
| Mohegan Lake, NY | $37.81 | $37.60 – $45.34 | 2,223 | 2 |
| Cheriton, VA | $69.86 | $69.86 – $69.86 | 2,222 | 1 |
| Forest City, PA | $0.57 | $0.57 – $0.57 | 2,221 | 2 |
| Hersey, MI | $71.21 | $71.21 – $71.21 | 2,219 | 1 |
| Pewee Valley, KY | $32.83 | $32.83 – $32.83 | 2,215 | 1 |
| Caryville, TN | $29.30 | $29.30 – $29.30 | 2,215 | 1 |
| Lyle, WA | $38.92 | $38.92 – $38.92 | 2,211 | 1 |
| Lincoln, KS | $221.29 | $150.85 – $222.19 | 2,210 | 2 |
| Richmond, MI | $59.35 | $46.83 – $72.66 | 2,209 | 2 |
| Beaver, OH | $52.68 | $52.68 – $52.68 | 2,208 | 1 |
| Yeadon, PA | $4.75 | $4.75 – $4.75 | 2,208 | 1 |
| E. Wareham, MA | $36.65 | $36.65 – $36.65 | 2,207 | 1 |
| Ipswich, SD | $72.27 | $72.27 – $72.27 | 2,207 | 1 |
| Brooklyn, MI | $79.59 | $62.12 – $146.53 | 2,205 | 4 |
| Mc Leansville, NC | $34.06 | $25.27 – $34.51 | 2,203 | 2 |
| Bayview, WI | $27.27 | $25.80 – $33.26 | 2,202 | 2 |
| North Berwick, ME | $30.50 | $30.49 – $30.97 | 2,201 | 2 |
| Winlock, WA | $27.58 | $22.66 – $41.22 | 2,199 | 3 |
| Waite Park, MN | $72.44 | $50.63 – $113.80 | 2,198 | 6 |
| Donora, PA | $52.72 | $52.72 – $52.72 | 2,198 | 1 |
| Oakville, WA | $48.06 | $40.65 – $52.24 | 2,196 | 2 |
| Mt. Vernon, NY | $40.34 | $15.55 – $67.81 | 2,195 | 2 |
| Clinton, MA | $61.64 | $30.03 – $78.90 | 2,195 | 7 |
| Olyphant, PA | $33.80 | $25.83 – $40.93 | 2,195 | 3 |
| Niagra Falls, NY | $84.13 | $84.13 – $84.13 | 2,194 | 1 |
| Carrizozo, NM | $98.93 | $39.49 – $108.94 | 2,193 | 3 |
| Tanana, AK | $338.89 | $338.67 – $339.55 | 2,191 | 2 |
| Princeton, WI | $38.79 | $38.79 – $38.79 | 2,190 | 1 |
| Bayard, NM | $99.30 | $9.31 – $107.17 | 2,187 | 2 |
| Spring Valley, AZ | $49.77 | $11.38 – $50.52 | 2,187 | 3 |
| Waurika, OK | $185.98 | $69.89 – $223.88 | 2,183 | 3 |
| Washington Township, NJ | $42.87 | $42.87 – $42.87 | 2,182 | 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.