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 |
|---|---|---|---|---|
| Leoti, KS | $168.18 | $34.52 – $300.68 | 1,576 | 4 |
| Lincoln Park, NJ | $104.40 | $28.65 – $110.99 | 1,574 | 2 |
| Turtle Lake, WI | $34.10 | $15.43 – $62.59 | 1,574 | 5 |
| Rewood City, CA | $99.09 | $99.09 – $99.09 | 1,572 | 1 |
| Mannford, OK | $92.93 | $65.71 – $108.13 | 1,572 | 3 |
| Welches, OR | $53.92 | $48.14 – $58.27 | 1,572 | 2 |
| Mountain Brk, AL | $31.06 | $0.00 – $68.17 | 1,572 | 6 |
| Yanceyille, NC | $69.24 | $69.24 – $69.24 | 1,571 | 1 |
| Blakely, GA | $43.35 | $19.55 – $56.29 | 1,570 | 3 |
| Tujillo Alto, PR | $3.61 | $3.61 – $3.61 | 1,570 | 1 |
| Texline, TX | $54.49 | $54.49 – $54.49 | 1,570 | 1 |
| Mt. Vernon, IL | $4.99 | $4.99 – $4.99 | 1,570 | 1 |
| Weatherly, PA | $38.31 | $37.54 – $38.83 | 1,568 | 2 |
| Pine Bush, NY | $91.84 | $71.05 – $135.87 | 1,567 | 3 |
| Pleasantville, IA | $34.22 | $34.22 – $34.22 | 1,567 | 1 |
| Lake City, CO | $61.15 | $59.26 – $61.16 | 1,566 | 2 |
| Newcomb, NY | $80.34 | $64.63 – $82.09 | 1,566 | 2 |
| Southampton, NJ | $44.12 | $35.96 – $48.52 | 1,565 | 2 |
| Evesham, NJ | $77.27 | $55.84 – $82.97 | 1,565 | 2 |
| Whitesboro, TX | $61.00 | $61.00 – $61.00 | 1,563 | 1 |
| Marcus, IA | $0.00 | $0.00 – $0.00 | 1,563 | 1 |
| Russell, PA | $39.78 | $24.70 – $44.45 | 1,563 | 2 |
| Sweet Briar, VA | $71.65 | $71.65 – $71.65 | 1,563 | 1 |
| Howards Grove, WI | $31.35 | $20.65 – $31.58 | 1,562 | 3 |
| Stirling, NJ | $48.99 | $38.33 – $53.29 | 1,562 | 3 |
| Orion, IL | $37.53 | $37.06 – $45.24 | 1,562 | 2 |
| Annapolis, MO | $82.01 | $82.01 – $82.01 | 1,561 | 1 |
| Fort Wainwright, AK | $39.25 | $20.74 – $824.92 | 1,559 | 5 |
| Williamsburg, WV | $31.04 | $27.94 – $37.34 | 1,559 | 2 |
| Watford City, ND | $71.89 | $44.73 – $137.87 | 1,558 | 10 |
| Westfield, PA | $0.26 | $0.26 – $0.26 | 1,557 | 1 |
| Fork Union, VA | $58.10 | $52.05 – $61.17 | 1,557 | 2 |
| Poinciana, FL | $12.04 | $1.92 – $26.12 | 1,552 | 3 |
| Wilburn, AR | $30.01 | $30.01 – $30.01 | 1,552 | 1 |
| Milford, UT | $87.09 | $87.09 – $87.09 | 1,552 | 1 |
| Stuttgart, AR | $34.14 | $5.24 – $39.07 | 1,551 | 4 |
| Arlington, IA | $16.58 | $0.00 – $24.63 | 1,549 | 2 |
| New Franklin, OH | $36.98 | $36.98 – $36.98 | 1,549 | 1 |
| Johnson City, TX | $36.80 | $24.47 – $37.31 | 1,547 | 2 |
| Air Force Academy, CO | $166.22 | $166.22 – $166.22 | 1,546 | 1 |
| Pine Island, MN | $55.11 | $42.37 – $64.55 | 1,546 | 4 |
| Wanatah, IN | $64.85 | $64.85 – $64.85 | 1,545 | 1 |
| Nickelsville, VA | $46.46 | $28.09 – $76.73 | 1,544 | 2 |
| Lone Pine, CA | $28.55 | $19.15 – $42.31 | 1,544 | 2 |
| Clinton, WI | $18.44 | $16.86 – $22.74 | 1,543 | 2 |
| Canadian, TX | $0.00 | $0.00 – $0.00 | 1,542 | 4 |
| Packwood, WA | $56.82 | $56.82 – $56.82 | 1,542 | 1 |
| Ridgway, PA | $58.56 | $0.00 – $60.57 | 1,542 | 4 |
| Presidio, TX | $1.06 | $0.29 – $7.78 | 1,540 | 2 |
| Clear Spring, MD | $94.07 | $94.07 – $94.07 | 1,538 | 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.