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 |
|---|---|---|---|---|
| New Stanton, PA | $51.23 | $51.23 – $51.23 | 1,309 | 1 |
| Ridgeville, SC | $382.09 | $382.09 – $382.09 | 1,309 | 1 |
| Little Egg Harbor, NJ | $39.44 | $0.56 – $61.83 | 1,308 | 2 |
| Eagle Bridge, NY | $80.39 | $80.39 – $80.39 | 1,306 | 1 |
| Finksburg, MD | $85.27 | $0.00 – $89.07 | 1,305 | 4 |
| Rogersville, AL | $47.47 | $29.34 – $58.13 | 1,305 | 2 |
| N Fond Du Lac, WI | $31.20 | $16.19 – $40.51 | 1,304 | 3 |
| Bunnlevel, NC | $54.57 | $54.57 – $54.57 | 1,302 | 1 |
| Montecito, CA | $24.39 | $1.10 – $51.76 | 1,302 | 3 |
| Yaphank, NY | $21.79 | $12.17 – $133.92 | 1,301 | 3 |
| Bernville, PA | $61.09 | $39.59 – $89.48 | 1,301 | 5 |
| Prentice, WI | $48.33 | $40.45 – $73.08 | 1,300 | 2 |
| Ft Riley, KS | $61.21 | $58.19 – $79.06 | 1,300 | 2 |
| New York, MA | $45.06 | $45.06 – $45.06 | 1,300 | 1 |
| Indian Harbour Beach, FL | $38.76 | $5.24 – $85.67 | 1,299 | 4 |
| Schdy, NY | $216.36 | $216.36 – $216.36 | 1,299 | 1 |
| Cidra, Puerto Rico, PR | $36.24 | $36.24 – $36.24 | 1,297 | 1 |
| Yountville, CA | $0.00 | $0.00 – $0.00 | 1,297 | 3 |
| Fort Loramie, OH | $42.47 | $42.47 – $42.47 | 1,294 | 1 |
| Grayson, GA | $72.54 | $0.00 – $318.18 | 1,291 | 6 |
| Goldbsoro, NC | $52.81 | $52.81 – $52.81 | 1,291 | 1 |
| Wimberley, TX | $78.20 | $65.95 – $78.68 | 1,290 | 2 |
| Mt Lebanon, PA | $45.10 | $45.10 – $45.10 | 1,289 | 1 |
| Southwest Ranches, FL | $42.34 | $26.47 – $43.00 | 1,289 | 2 |
| Pikeville, NC | $49.71 | $44.32 – $52.60 | 1,288 | 3 |
| Lacy Lakeview, TX | $37.21 | $36.41 – $37.83 | 1,288 | 2 |
| Bay Pines, FL | $62.45 | $0.00 – $76.75 | 1,287 | 5 |
| W Phoenix, AZ | $60.53 | $60.53 – $60.53 | 1,285 | 1 |
| Blairstown, NJ | $43.39 | $13.08 – $44.26 | 1,285 | 2 |
| Jericho, VT | $10.73 | $10.73 – $10.73 | 1,284 | 1 |
| West Bay Shore, NY | $58.01 | $58.01 – $58.01 | 1,284 | 1 |
| Walkersville, MD | $76.76 | $17.97 – $107.68 | 1,282 | 5 |
| Saugus, CA | $0.06 | $0.06 – $0.06 | 1,282 | 1 |
| Truchas, NM | $126.75 | $126.75 – $126.75 | 1,281 | 1 |
| Scotland, SD | $40.16 | $40.16 – $40.16 | 1,281 | 1 |
| Hamptonville, NC | $75.49 | $75.49 – $75.49 | 1,280 | 1 |
| Elkader, IA | $27.23 | $0.00 – $30.26 | 1,280 | 5 |
| Savoonga, AK | $397.28 | $318.62 – $453.14 | 1,280 | 8 |
| Missionviejo, CA | $40.28 | $40.28 – $40.28 | 1,279 | 1 |
| Plains, KS | $134.90 | $42.65 – $170.33 | 1,279 | 2 |
| Western Springs, IL | $60.44 | $6.58 – $64.76 | 1,278 | 2 |
| Waretown, NJ | $37.45 | $37.45 – $37.45 | 1,278 | 1 |
| South Floral Park, NY | $86.97 | $86.97 – $86.97 | 1,276 | 1 |
| Park Hill, OK | $37.01 | $0.00 – $59.95 | 1,273 | 3 |
| Graceville, FL | $22.49 | $19.35 – $23.37 | 1,273 | 3 |
| Luna Pier, MI | $41.42 | $41.42 – $41.42 | 1,273 | 1 |
| Chetopa, KS | $85.77 | $59.10 – $173.71 | 1,272 | 2 |
| Yale, VA | $54.02 | $54.02 – $54.02 | 1,271 | 1 |
| Plattsmouth, NE | $104.92 | $37.11 – $138.90 | 1,269 | 3 |
| Gurley, AL | $2.51 | $1.79 – $27.16 | 1,267 | 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.