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 |
|---|---|---|---|---|
| St. Johns, AZ | $0.23 | $0.00 – $1.56 | 1,790 | 2 |
| Henning, MN | $163.13 | $152.03 – $168.81 | 1,790 | 3 |
| Freeman, SD | $38.26 | $38.26 – $38.26 | 1,789 | 1 |
| New Creek, WV | $95.30 | $95.30 – $95.30 | 1,789 | 1 |
| Dunellen, NJ | $27.17 | $25.54 – $37.88 | 1,789 | 3 |
| Guilford, ME | $11.86 | $11.86 – $11.86 | 1,786 | 1 |
| Altamonte, FL | $51.33 | $51.33 – $51.33 | 1,783 | 1 |
| Anson, TX | $18.01 | $9.39 – $30.06 | 1,782 | 3 |
| Wittenberg, WI | $50.16 | $29.46 – $77.75 | 1,782 | 4 |
| Tenaha, TX | $11.49 | $11.49 – $11.49 | 1,780 | 1 |
| Canada, KY | $47.70 | $47.70 – $47.70 | 1,779 | 1 |
| West Point, UT | $63.82 | $6.22 – $78.04 | 1,779 | 5 |
| Island Lake, IL | $51.97 | $51.97 – $51.97 | 1,773 | 1 |
| Erdenheim, PA | $50.86 | $37.97 – $60.43 | 1,766 | 5 |
| Chisholm, MN | $118.97 | $99.81 – $128.90 | 1,766 | 3 |
| Rochester, PA | $40.53 | $2.50 – $42.91 | 1,762 | 2 |
| West Lebanon, NH | $68.28 | $1.47 – $96.10 | 1,761 | 4 |
| Woobridge, VA | $65.51 | $65.51 – $65.51 | 1,759 | 1 |
| Rosemount, MN | $69.65 | $50.31 – $80.91 | 1,756 | 7 |
| Southside, AL | $27.15 | $0.00 – $58.18 | 1,756 | 6 |
| Congers, NY | $72.67 | $14.12 – $109.61 | 1,755 | 3 |
| Milford, IA | $33.47 | $33.47 – $33.47 | 1,753 | 1 |
| Cicero Ny, NY | $68.64 | $68.64 – $68.64 | 1,751 | 1 |
| Centerville, MA | $43.26 | $0.00 – $46.10 | 1,751 | 3 |
| Bronson, MI | $61.15 | $59.11 – $70.74 | 1,749 | 2 |
| Millcreek, UT | $73.62 | $0.00 – $75.80 | 1,749 | 3 |
| Plainview, MN | $37.57 | $27.25 – $55.99 | 1,749 | 3 |
| Silver Springs, NV | $37.27 | $0.00 – $47.04 | 1,748 | 3 |
| Rangely, CO | $50.67 | $8.44 – $58.94 | 1,748 | 4 |
| Farmer City, IL | $0.00 | $0.00 – $0.00 | 1,746 | 1 |
| Shallowater, TX | $27.00 | $26.91 – $27.09 | 1,743 | 2 |
| Utica, MS | $18.91 | $15.78 – $38.95 | 1,742 | 2 |
| Luling, TX | $26.60 | $0.00 – $46.98 | 1,742 | 5 |
| Fewtus, MO | $36.75 | $36.75 – $36.75 | 1,740 | 1 |
| East Rochester, NY | $85.91 | $85.91 – $85.91 | 1,739 | 1 |
| Jackman, ME | $1.44 | $1.44 – $1.44 | 1,738 | 1 |
| Logan Township, NJ | $11.34 | $2.02 – $18.23 | 1,736 | 2 |
| Wellsville, OH | $30.32 | $27.29 – $114.77 | 1,735 | 2 |
| Wall, SD | $61.05 | $60.60 – $76.15 | 1,735 | 2 |
| Reynoldsville, PA | $45.15 | $29.31 – $48.54 | 1,735 | 3 |
| Nellis, WV | $54.97 | $50.19 – $56.40 | 1,734 | 2 |
| Meridianville, AL | $16.89 | $0.13 – $50.58 | 1,733 | 4 |
| So Hadley, MA | $35.62 | $35.62 – $35.62 | 1,732 | 1 |
| Blissfield, MI | $46.45 | $46.45 – $46.45 | 1,731 | 1 |
| Silt, CO | $43.60 | $43.60 – $43.60 | 1,731 | 1 |
| Centerbrook, CT | $52.81 | $28.72 – $55.39 | 1,728 | 2 |
| Kanarraville, UT | $55.72 | $55.72 – $55.72 | 1,726 | 1 |
| Coxsackie, NY | $74.92 | $1.05 – $78.51 | 1,726 | 4 |
| Cisco, TX | $37.97 | $13.00 – $39.71 | 1,723 | 3 |
| Freedom, WI | $42.79 | $42.79 – $42.79 | 1,722 | 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.