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 |
|---|---|---|---|---|
| Chesapeake Beach, MD | $125.32 | $74.83 – $133.93 | 2,119 | 4 |
| Sheppard Afb, TX | $87.85 | $87.85 – $87.85 | 2,119 | 1 |
| Bismarck, AR | $23.06 | $23.00 – $32.02 | 2,118 | 2 |
| Littleton, MA | $98.93 | $41.22 – $132.31 | 2,117 | 3 |
| Fort Calhoun, NE | $58.91 | $52.91 – $99.10 | 2,116 | 3 |
| Kingston, NH | $43.74 | $31.73 – $48.40 | 2,112 | 4 |
| Bonduel, WI | $40.65 | $38.11 – $42.44 | 2,109 | 3 |
| Bassett, NE | $88.92 | $74.13 – $134.97 | 2,109 | 5 |
| Allston, MA | $44.41 | $25.43 – $59.85 | 2,106 | 4 |
| Hamilton, IN | $53.62 | $53.62 – $53.62 | 2,106 | 1 |
| Marblehead, OH | $39.76 | $19.97 – $40.80 | 2,106 | 3 |
| Cazenovia, NY | $79.05 | $51.53 – $87.67 | 2,103 | 5 |
| Lovingston, VA | $62.51 | $62.51 – $62.51 | 2,100 | 1 |
| Ivor, VA | $47.46 | $13.34 – $68.28 | 2,098 | 4 |
| La Crescenta, CA | $7.43 | $5.20 – $97.68 | 2,097 | 3 |
| Wheatley Heights, NY | $81.24 | $47.00 – $82.12 | 2,097 | 2 |
| Shushan, NY | $82.15 | $82.15 – $82.15 | 2,096 | 1 |
| San Saba, TX | $43.36 | $43.36 – $43.36 | 2,096 | 1 |
| Palmyra, MO | $47.03 | $0.00 – $68.19 | 2,094 | 5 |
| St Peters, MO | $55.57 | $15.89 – $82.70 | 2,094 | 4 |
| Morrisville, NY | $81.88 | $64.17 – $94.93 | 2,094 | 3 |
| Lusk, WY | $1.63 | $1.63 – $1.63 | 2,093 | 1 |
| Mcdermott, OH | $37.57 | $37.57 – $37.57 | 2,092 | 1 |
| Chesterbrook, PA | $62.32 | $0.65 – $63.61 | 2,091 | 2 |
| Middleborough, MA | $28.05 | $28.05 – $28.05 | 2,090 | 1 |
| Unalakleet, AK | $392.21 | $215.94 – $444.70 | 2,086 | 8 |
| Dendron, VA | $61.58 | $25.11 – $66.61 | 2,086 | 3 |
| Davis Monthan Afb, AZ | $72.15 | $72.15 – $72.15 | 2,086 | 1 |
| Mount Olive, MS | $70.53 | $53.02 – $82.28 | 2,086 | 2 |
| Lake Hiawatha, NJ | $10.55 | $9.79 – $21.40 | 2,085 | 2 |
| Champions Gate, FL | $28.25 | $27.58 – $50.51 | 2,082 | 2 |
| Littlefield, AZ | $0.15 | $0.15 – $0.15 | 2,081 | 1 |
| Polk City, IA | $38.24 | $32.42 – $318.75 | 2,079 | 3 |
| Ellenboro, WV | $17.74 | $17.74 – $17.74 | 2,077 | 1 |
| New Hven, CT | $0.00 | $0.00 – $0.00 | 2,074 | 1 |
| Maxwell, IA | $0.01 | $0.01 – $0.01 | 2,073 | 1 |
| Sutton, NE | $156.69 | $40.98 – $241.81 | 2,070 | 4 |
| Prather, CA | $1.65 | $0.00 – $1.86 | 2,070 | 2 |
| Belle Plaine, MN | $59.47 | $56.86 – $71.95 | 2,066 | 3 |
| Rollinsford, NH | $39.89 | $39.89 – $39.89 | 2,065 | 1 |
| Fort Mc Coy, FL | $33.30 | $33.30 – $33.30 | 2,064 | 1 |
| Lisbon, ME | $30.20 | $30.20 – $30.20 | 2,060 | 1 |
| Mtn. Village, AK | $219.57 | $0.00 – $399.47 | 2,057 | 3 |
| Akiak, AK | $61.61 | $0.00 – $111.28 | 2,057 | 3 |
| Lost Hills, CA | $30.65 | $22.24 – $54.66 | 2,057 | 3 |
| Independence, WI | $10.45 | $10.45 – $10.45 | 2,056 | 1 |
| Lake, MS | $72.59 | $18.30 – $81.47 | 2,056 | 2 |
| Moorcroft, WY | $143.93 | $0.00 – $175.98 | 2,055 | 3 |
| Hebron, OH | $46.42 | $0.00 – $47.04 | 2,053 | 2 |
| Valley View, PA | $34.27 | $33.83 – $36.56 | 2,052 | 2 |
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.