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 |
|---|---|---|---|---|
| Ivanhoe, MN | $86.50 | $77.80 – $115.86 | 1,067 | 2 |
| East Yracuse, NY | $74.64 | $74.64 – $74.64 | 1,067 | 1 |
| Etta, MS | $60.89 | $56.19 – $81.64 | 1,066 | 2 |
| Akron, PA | $44.44 | $44.44 – $44.44 | 1,066 | 1 |
| Cape May, NJ | $56.88 | $46.67 – $87.62 | 1,066 | 3 |
| Enoch, UT | $62.78 | $59.21 – $66.03 | 1,065 | 2 |
| Centerville, SD | $89.02 | $89.02 – $89.02 | 1,064 | 1 |
| Langston, OK | $20.82 | $20.82 – $20.82 | 1,063 | 1 |
| Chattahoochee, FL | $22.06 | $19.38 – $22.14 | 1,062 | 2 |
| West Collingswood, NJ | $86.02 | $77.05 – $88.48 | 1,061 | 3 |
| Soldiers Grove, WI | $99.23 | $27.83 – $394.04 | 1,060 | 4 |
| Conneautville, PA | $58.15 | $58.15 – $58.15 | 1,059 | 1 |
| Mifflinville, PA | $44.93 | $44.93 – $44.93 | 1,058 | 1 |
| Marshville, NC | $49.24 | $2.07 – $80.24 | 1,057 | 3 |
| Stockton, MO | $100.30 | $42.83 – $108.99 | 1,057 | 3 |
| East Freedom, PA | $63.65 | $63.65 – $63.65 | 1,057 | 1 |
| Nutter Fort, WV | $66.79 | $66.79 – $66.79 | 1,055 | 1 |
| Royal City, WA | $148.74 | $51.91 – $541.44 | 1,054 | 4 |
| Groton, NY | $123.07 | $123.07 – $123.07 | 1,052 | 1 |
| Moore, SC | $41.22 | $39.63 – $59.13 | 1,052 | 4 |
| Delanson, NY | $45.50 | $45.50 – $45.50 | 1,051 | 1 |
| N. Vassalboro, ME | $49.50 | $49.50 – $49.50 | 1,050 | 1 |
| Vinton, OH | $24.53 | $24.53 – $24.53 | 1,050 | 1 |
| Sag Harbor, NY | $92.97 | $91.44 – $121.59 | 1,048 | 2 |
| Bayport, NY | $103.58 | $79.49 – $112.52 | 1,047 | 4 |
| Moreauville, LA | $78.85 | $78.85 – $78.85 | 1,046 | 1 |
| Hinckley, OH | $52.60 | $13.53 – $307.68 | 1,046 | 4 |
| Twin Bridges, MT | $12.05 | $0.00 – $66.01 | 1,046 | 2 |
| Mt. Lakes, NJ | $51.75 | $51.75 – $51.75 | 1,045 | 1 |
| Galthersburg, MD | $96.46 | $96.46 – $96.46 | 1,045 | 1 |
| Cullom, IL | $0.00 | $0.00 – $0.00 | 1,045 | 1 |
| Skagway, AK | $196.66 | $0.00 – $527.86 | 1,044 | 6 |
| Northboro, MA | $67.41 | $67.41 – $67.41 | 1,044 | 1 |
| Noroflk, NE | $72.95 | $72.95 – $72.95 | 1,043 | 1 |
| Ripley, NY | $45.22 | $45.22 – $45.22 | 1,042 | 1 |
| Buzzards Bay, MA | $84.89 | $0.00 – $427.00 | 1,042 | 5 |
| Manhattan, NY | $68.84 | $63.25 – $139.25 | 1,041 | 3 |
| Noxapater, MS | $37.26 | $37.26 – $37.26 | 1,041 | 1 |
| Angola, LA | $57.44 | $57.44 – $57.44 | 1,041 | 1 |
| Kimberly, AL | $67.33 | $66.61 – $67.80 | 1,041 | 2 |
| Rumson, NJ | $35.26 | $35.26 – $35.26 | 1,039 | 1 |
| Bayard, NE | $119.26 | $119.26 – $119.26 | 1,039 | 1 |
| Secacus, NJ | $56.83 | $56.83 – $56.83 | 1,038 | 1 |
| Fruite Cove, FL | $42.01 | $42.01 – $42.01 | 1,038 | 1 |
| Barrett, MN | $56.72 | $56.72 – $56.72 | 1,037 | 1 |
| Mcclearly, WA | $50.00 | $50.00 – $50.00 | 1,036 | 1 |
| Washburn, ME | $6.11 | $6.11 – $6.11 | 1,035 | 1 |
| New Britain, PA | $43.69 | $33.60 – $45.70 | 1,034 | 2 |
| Rockwood, MI | $16.99 | $16.99 – $16.99 | 1,034 | 1 |
| Greenfield Township, PA | $0.00 | $0.00 – $0.00 | 1,034 | 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.