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 |
|---|---|---|---|---|
| Wesley, IA | $34.54 | $34.54 – $34.54 | 1,267 | 1 |
| Dyersville, IA | $30.19 | $8.43 – $34.00 | 1,267 | 5 |
| Lorena, TX | $8.36 | $8.36 – $8.36 | 1,266 | 1 |
| Old Forge, NY | $37.56 | $34.02 – $68.07 | 1,266 | 3 |
| Edgewater, CO | $370.47 | $370.47 – $370.47 | 1,265 | 1 |
| Garnavillo, IA | $0.14 | $0.14 – $0.14 | 1,265 | 1 |
| Botkins, OH | $45.28 | $29.88 – $45.49 | 1,264 | 2 |
| Kellyville, OK | $109.84 | $109.84 – $109.84 | 1,261 | 1 |
| Ball Ground, GA | $31.54 | $14.99 – $31.82 | 1,261 | 2 |
| Assumption, IL | $0.18 | $0.18 – $0.18 | 1,260 | 1 |
| Necedah, WI | $58.90 | $58.90 – $58.90 | 1,258 | 1 |
| Clay City, IL | $0.00 | $0.00 – $0.00 | 1,258 | 1 |
| Mentone, IN | $78.47 | $71.19 – $81.07 | 1,255 | 2 |
| Clarence, NY | $57.67 | $37.47 – $81.29 | 1,255 | 5 |
| Dorset, VT | $29.48 | $29.48 – $29.48 | 1,254 | 1 |
| Jim Thorpe, PA | $38.71 | $1.09 – $41.00 | 1,252 | 3 |
| Williamsburg, MI | $44.78 | $14.09 – $50.18 | 1,252 | 3 |
| West Baldwin, ME | $36.38 | $36.38 – $36.38 | 1,250 | 1 |
| Schnectady, NY | $36.00 | $36.00 – $36.00 | 1,250 | 1 |
| Lawndale, NC | $21.88 | $0.00 – $60.85 | 1,249 | 2 |
| Homer, MI | $3.47 | $3.47 – $3.47 | 1,247 | 1 |
| Yellow Spgs, OH | $15.68 | $15.68 – $15.68 | 1,246 | 1 |
| Huntland, TN | $32.84 | $32.35 – $33.07 | 1,245 | 2 |
| Pine Grove, CA | $28.59 | $28.59 – $28.59 | 1,245 | 1 |
| Gladstone, MD | $44.04 | $44.04 – $44.04 | 1,244 | 1 |
| Genoa, OH | $37.11 | $31.96 – $45.65 | 1,244 | 4 |
| Galesville, MD | $114.05 | $114.05 – $114.05 | 1,243 | 1 |
| Pantego, TX | $37.97 | $37.97 – $37.97 | 1,242 | 1 |
| Oil City, PA | $50.20 | $8.19 – $52.95 | 1,241 | 6 |
| Tierra Amarilla, NM | $17.33 | $17.33 – $17.33 | 1,241 | 1 |
| Mekoryuk, AK | $439.28 | $439.28 – $439.28 | 1,240 | 1 |
| Haskell, NJ | $29.12 | $29.07 – $33.79 | 1,240 | 2 |
| Hastings, PA | $45.65 | $45.65 – $45.65 | 1,240 | 1 |
| Garden City Park, NY | $91.78 | $42.52 – $98.50 | 1,239 | 3 |
| Queen Anne, MD | $43.54 | $43.54 – $43.54 | 1,238 | 1 |
| Dunlap, IL | $51.54 | $33.61 – $51.85 | 1,238 | 2 |
| Fortworth, TX | $60.52 | $60.52 – $60.52 | 1,237 | 1 |
| Glidden, IA | $26.73 | $26.73 – $26.73 | 1,237 | 1 |
| Paullina, IA | $2.22 | $0.00 – $11.11 | 1,237 | 3 |
| Colchester, IL | $0.00 | $0.00 – $0.00 | 1,236 | 1 |
| Sunol, CA | $87.45 | $87.45 – $87.45 | 1,236 | 1 |
| Fort Eustis, VA | $74.80 | $44.79 – $91.32 | 1,235 | 4 |
| Warrenton, GA | $45.56 | $6.88 – $89.39 | 1,235 | 2 |
| Churchton, MD | $97.16 | $5.61 – $99.83 | 1,235 | 2 |
| Nokomis, FL | $61.37 | $29.38 – $63.19 | 1,234 | 3 |
| Fort Davis, TX | $26.48 | $26.48 – $26.48 | 1,233 | 1 |
| Perryopolis, PA | $36.53 | $36.53 – $36.53 | 1,233 | 1 |
| Weare, NH | $66.41 | $66.41 – $66.41 | 1,232 | 1 |
| Colfax, CA | $0.44 | $0.41 – $0.52 | 1,231 | 2 |
| Driftwood, TX | $50.67 | $50.67 – $50.67 | 1,229 | 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.