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 |
|---|---|---|---|---|
| Indianapollis, IN | $44.68 | $44.68 – $44.68 | 1,229 | 1 |
| Bridgeport, OH | $35.71 | $35.71 – $35.71 | 1,229 | 1 |
| Leicester, MA | $87.26 | $87.26 – $87.26 | 1,228 | 1 |
| Park City, KS | $19.80 | $0.00 – $32.80 | 1,228 | 4 |
| Elgin, AZ | $103.10 | $103.10 – $103.10 | 1,228 | 1 |
| Grawn, MI | $69.31 | $69.31 – $69.31 | 1,228 | 1 |
| La Push, WA | $37.77 | $37.77 – $37.77 | 1,227 | 1 |
| Bowdon, GA | $0.00 | $0.00 – $0.00 | 1,226 | 1 |
| Lyndon, VT | $23.88 | $9.45 – $34.22 | 1,225 | 5 |
| Ratcliff, AR | $30.05 | $5.43 – $30.34 | 1,225 | 2 |
| Walhalla, SC | $55.39 | $38.13 – $74.72 | 1,224 | 5 |
| Hallowell, ME | $50.75 | $49.03 – $51.69 | 1,224 | 2 |
| Harper, KS | $101.02 | $67.56 – $101.74 | 1,224 | 2 |
| Crofton, KY | $23.86 | $3.67 – $25.54 | 1,222 | 2 |
| Sorrento, FL | $13.31 | $10.26 – $297.42 | 1,222 | 2 |
| Ordway, CO | $85.80 | $85.80 – $85.80 | 1,222 | 1 |
| Trinity, TX | $90.86 | $0.00 – $115.11 | 1,221 | 3 |
| Timberlake, OH | $26.09 | $26.09 – $26.09 | 1,221 | 1 |
| Flagler, CO | $25.94 | $25.94 – $25.94 | 1,218 | 1 |
| Watson, IL | $58.98 | $58.98 – $58.98 | 1,217 | 1 |
| Marcy, NY | $181.71 | $1.16 – $224.14 | 1,217 | 3 |
| Sagamore Hills, OH | $25.19 | $24.42 – $26.06 | 1,217 | 2 |
| Ridgeley, WV | $45.50 | $16.43 – $56.33 | 1,217 | 4 |
| Fort Mcdowell, AZ | $79.19 | $60.50 – $427.00 | 1,216 | 2 |
| Curtis, MI | $27.62 | $27.62 – $27.62 | 1,216 | 1 |
| Newport, MN | $81.77 | $81.77 – $81.77 | 1,215 | 1 |
| Saipan, MP | $67.03 | $1.74 – $494.43 | 1,214 | 5 |
| Long Lake, NY | $71.04 | $71.04 – $71.04 | 1,214 | 1 |
| Waikoloa, HI | $124.52 | $122.21 – $195.95 | 1,214 | 2 |
| Fort Pierre, SD | $106.91 | $0.00 – $113.33 | 1,213 | 3 |
| Glenwood Spgs, CO | $44.78 | $43.46 – $56.70 | 1,212 | 5 |
| Elim, AK | $399.41 | $354.88 – $443.04 | 1,212 | 5 |
| North Huntington, PA | $40.06 | $40.06 – $40.06 | 1,211 | 1 |
| Iliamna, AK | $158.30 | $95.60 – $342.29 | 1,211 | 4 |
| Stockbridge, MA | $45.12 | $17.54 – $46.53 | 1,210 | 2 |
| Casa, AR | $45.79 | $45.79 – $45.79 | 1,208 | 1 |
| Monroe Twp, NJ | $62.70 | $28.55 – $118.23 | 1,206 | 4 |
| Brownstown, IN | $41.21 | $41.21 – $41.21 | 1,205 | 1 |
| Atherton, CA | $39.35 | $1.22 – $106.73 | 1,205 | 3 |
| Ashford, CT | $23.82 | $0.00 – $27.30 | 1,205 | 3 |
| Columbus, NM | $98.09 | $9.95 – $104.19 | 1,204 | 2 |
| Harrisville, PA | $36.99 | $31.92 – $42.06 | 1,204 | 2 |
| Valley Cottage, NY | $92.02 | $0.46 – $130.20 | 1,204 | 8 |
| Annandale On Hudson, NY | $3.14 | $3.14 – $3.14 | 1,203 | 1 |
| Sugar Mountain, NC | $56.04 | $56.04 – $56.04 | 1,201 | 1 |
| Lochgelly, WV | $0.00 | $0.00 – $0.01 | 1,200 | 2 |
| Indianola, OK | $93.40 | $93.40 – $93.40 | 1,200 | 1 |
| Stebbins, AK | $414.98 | $402.43 – $455.14 | 1,199 | 5 |
| Vance, SC | $173.87 | $172.85 – $266.85 | 1,199 | 2 |
| Whiting, ME | $41.85 | $41.85 – $41.85 | 1,196 | 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.