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 |
|---|---|---|---|---|
| Cooksville, IL | $29.83 | $29.83 – $29.83 | 1,468 | 1 |
| Colona, IL | $30.77 | $30.77 – $30.77 | 1,468 | 1 |
| Rockaway Beach, OR | $42.74 | $42.74 – $42.74 | 1,468 | 1 |
| New Baden, IL | $0.25 | $0.00 – $25.90 | 1,467 | 2 |
| Audubon, NJ | $59.59 | $6.95 – $117.78 | 1,467 | 5 |
| Wonewoc, WI | $43.07 | $42.37 – $54.17 | 1,467 | 2 |
| Mc Cormick, SC | $150.31 | $27.77 – $152.52 | 1,467 | 2 |
| Ekalaka, MT | $9.39 | $0.11 – $36.89 | 1,467 | 2 |
| Redgranite, WI | $25.55 | $15.79 – $27.46 | 1,467 | 3 |
| Iola, WI | $27.34 | $27.07 – $35.70 | 1,466 | 2 |
| Alexander, NY | $41.97 | $41.97 – $41.97 | 1,463 | 1 |
| Virgnia, IL | $53.02 | $53.02 – $53.02 | 1,463 | 1 |
| Elsberry, MO | $120.76 | $120.76 – $120.76 | 1,462 | 1 |
| Canaan, CT | $62.20 | $22.13 – $85.49 | 1,461 | 5 |
| Verona, NY | $67.78 | $51.49 – $97.09 | 1,461 | 3 |
| Twin Lakes, WI | $37.37 | $14.43 – $39.16 | 1,461 | 5 |
| Tekamah, NE | $64.95 | $4.06 – $167.65 | 1,460 | 5 |
| S Dennis, MA | $53.31 | $53.31 – $53.31 | 1,460 | 1 |
| Los Ranchos, NM | $81.91 | $41.37 – $88.97 | 1,459 | 4 |
| Wellsburg, WV | $29.72 | $7.30 – $73.87 | 1,459 | 6 |
| North New Hyde Park, NY | $157.46 | $154.50 – $191.34 | 1,459 | 3 |
| Banner Elk, NC | $43.60 | $33.18 – $75.71 | 1,458 | 4 |
| Bridger, MT | $0.00 | $0.00 – $0.00 | 1,456 | 1 |
| Prospect Hill, NC | $35.12 | $35.12 – $35.12 | 1,455 | 1 |
| Kohler, WI | $27.72 | $22.10 – $37.08 | 1,454 | 5 |
| National Harbor, MD | $90.20 | $72.33 – $141.02 | 1,453 | 2 |
| Elmhurts, NY | $0.29 | $0.29 – $0.29 | 1,453 | 1 |
| Lake View, NY | $40.61 | $40.61 – $40.61 | 1,452 | 1 |
| Steinhatchee, FL | $26.84 | $26.84 – $26.84 | 1,451 | 1 |
| Colorado City, TX | $15.83 | $12.59 – $35.43 | 1,451 | 4 |
| Martinsville, NJ | $47.43 | $29.93 – $75.37 | 1,449 | 8 |
| Condon, OR | $52.52 | $51.28 – $57.46 | 1,449 | 2 |
| Bonaire, GA | $55.37 | $44.93 – $55.92 | 1,445 | 2 |
| Quemado, NM | $131.23 | $47.92 – $133.24 | 1,445 | 2 |
| Castl Rock, WA | $13.82 | $13.82 – $13.82 | 1,444 | 1 |
| New London, MO | $60.20 | $60.20 – $60.20 | 1,444 | 1 |
| Oakfield, NY | $70.55 | $70.55 – $70.55 | 1,444 | 1 |
| Tripler Amc, HI | $120.15 | $35.33 – $371.15 | 1,443 | 11 |
| Cascade, ID | $3.78 | $0.00 – $4.26 | 1,443 | 6 |
| Teec Nos Pos, AZ | $157.76 | $20.56 – $359.99 | 1,443 | 3 |
| Ft. Thomas, KY | $59.91 | $28.51 – $62.45 | 1,442 | 3 |
| Sharon Springs, KS | $163.56 | $163.56 – $163.56 | 1,440 | 1 |
| Ferguson, NC | $40.62 | $36.20 – $41.35 | 1,439 | 2 |
| Hastings On Hudson, NY | $89.72 | $5.47 – $152.55 | 1,439 | 6 |
| Fillmore, IN | $38.90 | $38.90 – $38.90 | 1,438 | 1 |
| Kingston, MO | $16.85 | $16.85 – $16.85 | 1,437 | 1 |
| Douglass Hills, KY | $72.33 | $72.33 – $72.33 | 1,432 | 1 |
| Arundel, ME | $23.84 | $18.92 – $26.31 | 1,432 | 2 |
| 00612, PR | $5.32 | $5.32 – $5.32 | 1,432 | 1 |
| Midway, KY | $43.20 | $42.15 – $53.35 | 1,431 | 2 |
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.