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 |
|---|---|---|---|---|
| Lena, LA | $39.33 | $39.33 – $39.33 | 1,144 | 1 |
| Croton Falss, NY | $81.45 | $81.45 – $81.45 | 1,144 | 1 |
| Seville, OH | $30.22 | $19.32 – $73.09 | 1,143 | 4 |
| Woodville, WI | $18.06 | $18.06 – $18.06 | 1,142 | 1 |
| Bailey, NC | $19.80 | $2.00 – $29.01 | 1,141 | 3 |
| Kensett, AR | $4.22 | $0.68 – $17.99 | 1,141 | 4 |
| North Salem, NY | $54.14 | $23.02 – $106.69 | 1,139 | 3 |
| Alfred, ME | $55.51 | $55.51 – $55.51 | 1,138 | 1 |
| Dover Afb, DE | $292.69 | $68.90 – $321.80 | 1,138 | 2 |
| Appleton City, MO | $105.29 | $76.46 – $108.57 | 1,136 | 3 |
| Killingly, CT | $73.10 | $73.10 – $73.10 | 1,136 | 1 |
| Sloan, IA | $0.11 | $0.11 – $0.11 | 1,135 | 1 |
| Holden, WV | $49.30 | $49.30 – $49.30 | 1,135 | 1 |
| Ft Greggadams, VA | $44.29 | $3.35 – $50.49 | 1,134 | 2 |
| N Sioux City, SD | $58.22 | $58.22 – $58.22 | 1,134 | 1 |
| Osburn, ID | $48.98 | $48.98 – $48.98 | 1,132 | 1 |
| Tiger, GA | $44.26 | $44.26 – $44.26 | 1,131 | 1 |
| Rosedale, MS | $42.87 | $42.87 – $42.87 | 1,130 | 1 |
| Atmautluak, AK | $0.00 | $0.00 – $0.00 | 1,130 | 2 |
| Alpine, TX | $56.46 | $21.75 – $79.23 | 1,129 | 5 |
| Rolesville, NC | $44.21 | $0.00 – $49.19 | 1,127 | 3 |
| Littleton, NC | $22.03 | $0.00 – $75.06 | 1,127 | 7 |
| Hill City, MN | $198.22 | $198.22 – $198.22 | 1,125 | 1 |
| La Volla, CA | $3.69 | $3.69 – $3.69 | 1,125 | 1 |
| Fremont, NC | $4.78 | $4.78 – $4.78 | 1,125 | 1 |
| Bellwood, IL | $36.43 | $21.12 – $43.69 | 1,124 | 3 |
| Arlington, OH | $43.69 | $38.43 – $47.11 | 1,123 | 2 |
| Richmond, OH | $29.50 | $29.50 – $29.50 | 1,121 | 1 |
| Snowshoe, WV | $69.09 | $69.09 – $69.09 | 1,121 | 1 |
| Goodman, MO | $116.40 | $116.40 – $116.40 | 1,120 | 1 |
| Texas, TX | $35.39 | $35.39 – $35.39 | 1,119 | 1 |
| Laurel Hill, NC | $26.55 | $26.55 – $26.55 | 1,118 | 1 |
| Oxford, FL | $25.61 | $10.38 – $29.24 | 1,117 | 3 |
| Ash Fork, AZ | $30.84 | $30.84 – $30.84 | 1,117 | 1 |
| Pentwater, MI | $5.71 | $5.71 – $5.71 | 1,116 | 1 |
| Nakina, NC | $7.77 | $7.77 – $7.77 | 1,116 | 1 |
| Counselor, NM | $141.21 | $141.21 – $141.21 | 1,115 | 1 |
| Cedar Grove, WI | $29.39 | $27.41 – $30.13 | 1,112 | 2 |
| Pittsburgh, KS | $20.54 | $20.54 – $20.54 | 1,112 | 1 |
| Apache, OK | $58.99 | $58.99 – $58.99 | 1,112 | 1 |
| Boring, MD | $107.49 | $107.49 – $107.49 | 1,111 | 1 |
| Belleville, WI | $19.49 | $14.59 – $36.54 | 1,110 | 10 |
| Gerogetown, OH | $61.51 | $61.51 – $61.51 | 1,110 | 1 |
| Swannanoa, NC | $109.41 | $69.36 – $110.03 | 1,110 | 2 |
| Little Canada, MN | $69.96 | $69.44 – $79.66 | 1,110 | 2 |
| Intervale, NH | $23.57 | $23.57 – $23.57 | 1,109 | 1 |
| Dearborn Hts, MI | $59.60 | $59.60 – $59.60 | 1,108 | 1 |
| Marlboro Township, NJ | $68.67 | $68.67 – $68.67 | 1,106 | 1 |
| Rio Piedrad, PR | $0.00 | $0.00 – $0.00 | 1,105 | 1 |
| Eastport, NY | $101.11 | $101.11 – $101.11 | 1,103 | 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.