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 |
|---|---|---|---|---|
| Sheffield, PA | $70.42 | $70.42 – $70.42 | 1,501 | 1 |
| Sabana Hoyos, PR | $0.29 | $0.00 – $0.31 | 1,501 | 2 |
| Clarksville, OH | $41.84 | $41.84 – $41.84 | 1,501 | 1 |
| Mt. Storm, WV | $10.57 | $0.00 – $14.45 | 1,500 | 2 |
| Wilbur, WA | $51.32 | $48.69 – $52.85 | 1,500 | 2 |
| Ft Walton Bch, FL | $58.39 | $58.39 – $58.39 | 1,499 | 1 |
| Mount Hope, WV | $66.14 | $66.14 – $66.14 | 1,499 | 1 |
| Ft Collins, CO | $62.88 | $62.88 – $62.88 | 1,499 | 1 |
| Lincroft, NJ | $34.58 | $0.00 – $114.63 | 1,497 | 3 |
| Ocean City, NJ | $22.21 | $1.47 – $65.13 | 1,494 | 6 |
| Shelby, IN | $45.09 | $45.09 – $45.09 | 1,494 | 1 |
| Penn Valley, CA | $19.85 | $0.00 – $21.94 | 1,493 | 3 |
| Chisago City, MN | $70.44 | $51.79 – $77.95 | 1,492 | 4 |
| Rancho Mirago, CA | $66.21 | $66.21 – $66.21 | 1,492 | 1 |
| Seneca, IL | $62.04 | $57.48 – $65.54 | 1,490 | 2 |
| Hancock, NY | $56.12 | $55.15 – $60.50 | 1,489 | 2 |
| Isanti, MN | $84.44 | $70.60 – $112.41 | 1,489 | 2 |
| Green Village, NJ | $51.83 | $51.83 – $51.83 | 1,489 | 1 |
| Elm Grove, WI | $36.85 | $0.00 – $65.59 | 1,489 | 4 |
| Poland, NY | $54.35 | $54.35 – $54.35 | 1,488 | 1 |
| East York, PA | $0.56 | $0.56 – $0.56 | 1,486 | 1 |
| N Billerica, MA | $38.05 | $38.05 – $38.05 | 1,486 | 1 |
| Perry, MI | $56.13 | $56.13 – $56.13 | 1,485 | 1 |
| Plainview, NE | $127.78 | $44.56 – $188.09 | 1,483 | 4 |
| Stronghurst, IL | $29.06 | $0.00 – $47.45 | 1,483 | 3 |
| Glendale, CO | $101.81 | $49.48 – $106.54 | 1,481 | 3 |
| Inez, TX | $34.83 | $34.83 – $34.83 | 1,481 | 1 |
| Cloverdale, OR | $58.99 | $58.99 – $58.99 | 1,480 | 1 |
| Gilbertsville, PA | $57.47 | $57.36 – $59.60 | 1,480 | 2 |
| Aurelia, IA | $0.00 | $0.00 – $0.00 | 1,479 | 1 |
| South Beloit, IL | $29.18 | $0.00 – $35.20 | 1,479 | 3 |
| Huntington, UT | $5.40 | $5.40 – $5.40 | 1,478 | 1 |
| Lava Hot Springs, ID | $19.53 | $1.20 – $52.09 | 1,477 | 2 |
| Seymour, IA | $4.81 | $0.03 – $25.80 | 1,477 | 3 |
| Greenville, MO | $16.52 | $14.51 – $16.68 | 1,477 | 2 |
| Center Ossipee, NH | $42.98 | $42.98 – $42.98 | 1,476 | 1 |
| Hico, WV | $0.93 | $0.00 – $3.86 | 1,476 | 2 |
| Mason, GA | $105.44 | $105.44 – $105.44 | 1,475 | 1 |
| Nanwalek, AK | $249.78 | $34.42 – $449.89 | 1,475 | 5 |
| Renner, LA | $38.22 | $38.22 – $38.22 | 1,475 | 1 |
| Fayette, IA | $3.12 | $0.10 – $23.54 | 1,475 | 2 |
| Boise City, OK | $124.20 | $53.78 – $133.81 | 1,475 | 3 |
| Middle Islana, NY | $63.47 | $63.47 – $63.47 | 1,475 | 1 |
| Leakey, TX | $79.30 | $79.30 – $79.30 | 1,474 | 1 |
| Polo, MO | $80.05 | $80.05 – $80.05 | 1,472 | 1 |
| Bloomsdale, MO | $86.93 | $3.66 – $110.66 | 1,472 | 8 |
| Rexford, NY | $117.26 | $39.52 – $122.39 | 1,471 | 2 |
| Sheridan, CO | $55.67 | $13.77 – $90.71 | 1,470 | 4 |
| Oceano, CA | $0.84 | $0.00 – $5.05 | 1,470 | 3 |
| Andover, NY | $100.47 | $69.25 – $215.62 | 1,469 | 3 |
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.