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 |
|---|---|---|---|---|
| Mt.Carmel, Il 62863, IL | $52.98 | $52.98 – $52.98 | 1,894 | 1 |
| Litchfield, NH | $53.29 | $53.29 – $53.29 | 1,894 | 1 |
| Sparta, GA | $103.83 | $3.84 – $145.80 | 1,894 | 2 |
| North Venice, FL | $32.72 | $10.61 – $125.07 | 1,892 | 11 |
| Palmer Township, PA | $34.74 | $7.96 – $38.69 | 1,891 | 4 |
| Lakemoor, IL | $57.13 | $47.66 – $57.73 | 1,890 | 2 |
| Sherrills Ford, NC | $53.16 | $42.33 – $53.55 | 1,889 | 3 |
| La Mesilla, NM | $70.60 | $70.60 – $70.60 | 1,888 | 1 |
| Howard, KS | $117.28 | $95.18 – $118.30 | 1,888 | 2 |
| Star, ID | $119.13 | $3.66 – $126.70 | 1,887 | 3 |
| Orr, MN | $556.69 | $485.75 – $594.29 | 1,885 | 4 |
| Ignacio, CO | $493.31 | $332.09 – $526.12 | 1,885 | 4 |
| Osterville, MA | $46.85 | $46.85 – $46.85 | 1,884 | 1 |
| Fort Howard, MD | $80.16 | $77.17 – $80.21 | 1,882 | 2 |
| Veazie, ME | $80.87 | $80.87 – $80.87 | 1,880 | 1 |
| Mt Gilead, NC | $52.09 | $52.09 – $52.09 | 1,880 | 1 |
| Big Sky, MT | $68.40 | $47.34 – $123.13 | 1,879 | 6 |
| Daingerfield, TX | $45.79 | $45.79 – $45.79 | 1,878 | 1 |
| Lake Crystal, MN | $67.71 | $58.41 – $81.09 | 1,876 | 3 |
| Cedarhusrt, NY | $68.86 | $68.86 – $68.86 | 1,874 | 1 |
| Cinti, OH | $41.34 | $41.34 – $41.34 | 1,873 | 1 |
| Sutton, AK | $376.56 | $338.54 – $408.83 | 1,871 | 2 |
| Greene, NY | $57.20 | $43.08 – $71.21 | 1,871 | 6 |
| Wyandotte, OK | $47.63 | $37.44 – $61.87 | 1,867 | 2 |
| Saint Maries, ID | $19.61 | $19.61 – $19.61 | 1,866 | 1 |
| Eva, AL | $53.01 | $52.81 – $67.75 | 1,862 | 2 |
| Oakton, VA | $72.00 | $26.20 – $90.76 | 1,861 | 3 |
| Corsica, PA | $17.32 | $17.32 – $17.32 | 1,861 | 1 |
| Bidwell, OH | $20.21 | $17.60 – $21.84 | 1,860 | 2 |
| Troy, KS | $163.67 | $163.67 – $163.67 | 1,860 | 1 |
| Montague, MI | $70.02 | $70.02 – $70.02 | 1,859 | 1 |
| Accomac, VA | $39.21 | $36.93 – $86.67 | 1,857 | 2 |
| Inola, OK | $108.69 | $108.69 – $108.69 | 1,857 | 1 |
| New Hartford, CT | $38.90 | $34.97 – $57.79 | 1,856 | 2 |
| N Bethesda, MD | $89.70 | $72.30 – $92.37 | 1,856 | 3 |
| Tuscon, AZ | $67.99 | $46.79 – $136.44 | 1,855 | 7 |
| Whitehouse Station, NJ | $77.11 | $42.73 – $92.39 | 1,855 | 4 |
| Jeffersonville, VT | $16.79 | $16.79 – $16.79 | 1,853 | 1 |
| Norwwod, MA | $91.02 | $91.02 – $91.02 | 1,850 | 1 |
| Dayton, NV | $55.40 | $6.52 – $63.92 | 1,849 | 3 |
| Lackland Afb, TX | $69.63 | $12.96 – $149.40 | 1,848 | 6 |
| Friend, NE | $73.51 | $46.90 – $113.70 | 1,848 | 5 |
| Saint Johns, FL | $34.08 | $23.67 – $52.98 | 1,847 | 4 |
| Cuba City, WI | $20.04 | $20.04 – $20.04 | 1,846 | 1 |
| Sstaten Island, NY | $34.17 | $34.17 – $34.17 | 1,844 | 1 |
| Hamlin, NY | $84.43 | $84.43 – $84.43 | 1,842 | 1 |
| Callaway, NE | $74.34 | $58.04 – $122.69 | 1,840 | 5 |
| Bannockburn, IL | $42.41 | $9.19 – $57.82 | 1,840 | 8 |
| St.Paul, MN | $77.08 | $77.08 – $77.08 | 1,840 | 1 |
| Pleasantville, NY | $77.58 | $21.97 – $92.60 | 1,839 | 6 |
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.