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 |
|---|---|---|---|---|
| Leesport, PA | $72.30 | $58.56 – $81.69 | 1,666 | 3 |
| Alma, NE | $96.65 | $27.46 – $110.96 | 1,665 | 8 |
| New Franken, WI | $39.49 | $34.90 – $39.64 | 1,665 | 2 |
| Pine Brook, NJ | $73.43 | $73.43 – $73.43 | 1,664 | 1 |
| Primghar, IA | $24.21 | $0.79 – $48.64 | 1,664 | 3 |
| Birmingham, IA | $0.00 | $0.00 – $0.00 | 1,664 | 1 |
| Bridgeport, IL | $44.30 | $43.95 – $45.04 | 1,662 | 2 |
| Goodman, MS | $31.97 | $31.97 – $31.97 | 1,662 | 1 |
| Spring Lake, MI | $59.47 | $1.38 – $76.24 | 1,662 | 6 |
| New Yor, NC | $74.87 | $74.87 – $74.87 | 1,660 | 1 |
| Finley, ND | $66.44 | $66.44 – $66.44 | 1,656 | 1 |
| Kongiganuk, AK | $260.16 | $260.16 – $260.16 | 1,654 | 1 |
| Whiteford, MD | $111.65 | $111.65 – $111.65 | 1,652 | 1 |
| Chicago Hts, IL | $46.98 | $46.98 – $46.98 | 1,652 | 1 |
| E Longmeadow, MA | $66.19 | $66.07 – $67.20 | 1,650 | 2 |
| Dayton, KY | $91.61 | $91.61 – $91.61 | 1,649 | 1 |
| Huntley, MT | $68.22 | $68.22 – $68.22 | 1,649 | 1 |
| Indian Orchard, MA | $56.45 | $42.34 – $64.66 | 1,649 | 3 |
| Roeland Park, KS | $261.11 | $3.77 – $502.22 | 1,648 | 5 |
| San Miguel, NM | $99.69 | $88.75 – $155.28 | 1,648 | 3 |
| Wardensville, WV | $8.20 | $0.00 – $11.36 | 1,645 | 2 |
| Village Of Palmetto Bay, FL | $51.38 | $2.31 – $86.22 | 1,643 | 7 |
| Tatum, NM | $183.09 | $173.52 – $237.66 | 1,643 | 2 |
| Wills Point, TX | $18.23 | $18.23 – $18.23 | 1,643 | 1 |
| Fairbank, IA | $23.71 | $23.71 – $23.71 | 1,643 | 1 |
| Gilbert, IA | $24.90 | $24.90 – $24.90 | 1,643 | 1 |
| Colon, MI | $2.38 | $2.38 – $2.38 | 1,641 | 1 |
| 29 Palms, CA | $30.44 | $30.44 – $30.44 | 1,641 | 1 |
| La Motte, IA | $32.77 | $32.77 – $32.77 | 1,640 | 1 |
| Tahoka, TX | $25.16 | $5.61 – $30.43 | 1,640 | 2 |
| Tonganoxie, KS | $53.99 | $27.42 – $129.20 | 1,640 | 5 |
| Enterprise, UT | $71.58 | $59.94 – $75.61 | 1,639 | 3 |
| West Blocton, AL | $0.00 | $0.00 – $0.00 | 1,637 | 1 |
| Olanta, SC | $107.37 | $9.68 – $218.48 | 1,637 | 4 |
| Louisburg, KS | $191.94 | $27.15 – $215.46 | 1,633 | 4 |
| East Rancho Dominguez, CA | $33.70 | $0.00 – $35.97 | 1,633 | 2 |
| New Caney, TX | $39.93 | $9.07 – $134.91 | 1,632 | 4 |
| Abita Springs, LA | $37.19 | $0.00 – $48.65 | 1,632 | 5 |
| Fountain Vly, CA | $68.16 | $68.16 – $68.16 | 1,632 | 1 |
| Adrian, OR | $121.57 | $121.57 – $121.57 | 1,631 | 1 |
| Ambridge, PA | $44.60 | $32.23 – $48.41 | 1,630 | 4 |
| Baileyville, ME | $25.97 | $25.97 – $25.97 | 1,630 | 1 |
| Beach, ND | $108.23 | $7.35 – $118.59 | 1,627 | 3 |
| Clarksboro, NJ | $28.77 | $8.66 – $31.01 | 1,627 | 2 |
| Karlstad, MN | $44.62 | $44.62 – $44.62 | 1,627 | 1 |
| Orleans, MA | $51.56 | $0.00 – $71.67 | 1,625 | 8 |
| Mckees Rocks, PA | $38.27 | $22.98 – $52.42 | 1,625 | 4 |
| Saddle River, NJ | $51.53 | $33.94 – $67.81 | 1,625 | 3 |
| Saltsburg, PA | $35.60 | $35.18 – $36.80 | 1,624 | 3 |
| Suamico, WI | $28.38 | $21.79 – $69.60 | 1,623 | 4 |
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.