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 |
|---|---|---|---|---|
| Holts Summit, MO | $58.36 | $55.67 – $102.50 | 1,102 | 3 |
| Spring Mills, PA | $46.63 | $27.85 – $52.19 | 1,100 | 4 |
| Stewart, OH | $19.27 | $0.00 – $21.07 | 1,100 | 2 |
| T Or C, NM | $113.00 | $101.23 – $231.56 | 1,100 | 3 |
| Armour, SD | $67.32 | $67.32 – $67.32 | 1,100 | 1 |
| Gonzalez, CA | $26.08 | $26.08 – $26.08 | 1,099 | 1 |
| South Russell, OH | $28.74 | $26.02 – $41.18 | 1,099 | 3 |
| Ausitn, TX | $90.62 | $90.62 – $90.62 | 1,097 | 1 |
| Clark, SD | $52.30 | $52.30 – $52.30 | 1,096 | 1 |
| Riggins, ID | $0.44 | $0.00 – $5.27 | 1,094 | 2 |
| Cross River, NY | $66.50 | $66.50 – $66.50 | 1,093 | 1 |
| Camargo, IL | $51.52 | $49.60 – $52.56 | 1,092 | 2 |
| Langley, KY | $27.99 | $27.99 – $27.99 | 1,092 | 1 |
| Huffman, TX | $82.03 | $21.51 – $141.43 | 1,092 | 3 |
| Boyd, TX | $43.79 | $38.72 – $45.38 | 1,092 | 2 |
| Perkinsville, VT | $83.55 | $83.55 – $83.55 | 1,091 | 1 |
| Hartington, NE | $79.65 | $36.35 – $88.51 | 1,091 | 3 |
| Sainte Genevieve, MO | $85.61 | $31.19 – $92.67 | 1,091 | 3 |
| Belle Harbor, NY | $92.55 | $61.31 – $102.44 | 1,090 | 2 |
| Arcadia, IN | $26.35 | $26.35 – $26.35 | 1,089 | 1 |
| Ansted, WV | $19.26 | $0.14 – $46.47 | 1,088 | 2 |
| Stone Ridge, VA | $75.94 | $70.29 – $76.27 | 1,088 | 2 |
| Fall Branch, TN | $49.41 | $49.41 – $49.41 | 1,087 | 1 |
| Rock Point, AZ | $31.14 | $29.81 – $76.60 | 1,087 | 2 |
| Canaan, NH | $28.17 | $15.22 – $40.21 | 1,085 | 5 |
| Hickory, MS | $55.01 | $52.99 – $55.09 | 1,085 | 2 |
| Moore Haven, FL | $40.36 | $20.85 – $48.81 | 1,085 | 3 |
| Upper Lake, CA | $17.85 | $17.85 – $17.85 | 1,083 | 1 |
| Conosburg, PA | $70.27 | $70.27 – $70.27 | 1,078 | 1 |
| Lake Park, FL | $17.93 | $0.00 – $38.40 | 1,078 | 6 |
| Antioch, IL | $33.72 | $24.60 – $48.71 | 1,078 | 3 |
| Yautat, AK | $442.90 | $442.90 – $442.90 | 1,078 | 1 |
| Akron, NY | $40.99 | $40.69 – $41.66 | 1,078 | 2 |
| Louisville, NE | $41.76 | $40.82 – $54.79 | 1,077 | 2 |
| Weiner, AR | $23.43 | $14.60 – $29.97 | 1,077 | 2 |
| Hulett, WY | $51.30 | $51.30 – $51.30 | 1,077 | 1 |
| Cairo, GA | $41.36 | $0.00 – $318.75 | 1,076 | 6 |
| Vernonia, OR | $77.68 | $67.91 – $78.04 | 1,076 | 2 |
| Franklin, NY | $108.84 | $89.71 – $119.49 | 1,076 | 2 |
| Speedwell, TN | $34.22 | $34.22 – $34.22 | 1,075 | 1 |
| Mcgregor, TX | $31.42 | $22.62 – $33.07 | 1,075 | 2 |
| Sun Lakes, AZ | $33.24 | $29.10 – $52.72 | 1,074 | 3 |
| Glasgow, MO | $63.24 | $63.24 – $63.24 | 1,072 | 1 |
| Avondale, LA | $0.00 | $0.00 – $0.00 | 1,072 | 2 |
| Bowie, TX | $12.67 | $0.46 – $29.25 | 1,071 | 5 |
| Red River, NM | $97.79 | $97.79 – $97.79 | 1,070 | 1 |
| Hammon, OK | $60.92 | $60.92 – $60.92 | 1,070 | 1 |
| West Lafayette Bra, IN | $36.81 | $36.81 – $36.81 | 1,070 | 1 |
| Greenwood, WI | $34.27 | $31.48 – $64.61 | 1,070 | 3 |
| Speedway, IN | $33.43 | $2.01 – $48.01 | 1,069 | 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.