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 |
|---|---|---|---|---|
| Havertown, NJ | $30.13 | $30.13 – $30.13 | 962 | 1 |
| Terry, MS | $48.81 | $13.68 – $83.58 | 962 | 5 |
| Oakwood, GA | $43.62 | $23.27 – $52.01 | 962 | 2 |
| Three Rivers, MA | $148.58 | $148.58 – $148.58 | 962 | 1 |
| Sweeny, TX | $27.02 | $27.02 – $27.02 | 962 | 1 |
| Kremmling, CO | $54.33 | $46.94 – $54.45 | 959 | 2 |
| Bayfield, WI | $22.58 | $21.88 – $24.06 | 958 | 2 |
| Albion, MI | $28.69 | $27.98 – $68.07 | 957 | 2 |
| Farnham, VA | $80.36 | $80.36 – $80.36 | 955 | 1 |
| Quinebaug, CT | $24.59 | $24.59 – $24.59 | 955 | 1 |
| Montgomery, MN | $67.34 | $65.50 – $87.02 | 954 | 3 |
| N Massapequa, NY | $45.63 | $45.63 – $45.63 | 953 | 1 |
| Ossineke, MI | $4.67 | $4.67 – $4.67 | 952 | 1 |
| Bartonville, TX | $32.62 | $24.14 – $37.09 | 952 | 4 |
| Eunice, NM | $106.89 | $106.89 – $106.89 | 951 | 1 |
| Navasota, TX | $41.74 | $0.00 – $48.12 | 950 | 4 |
| Ary, KY | $27.78 | $27.78 – $27.78 | 950 | 1 |
| Big Piney, WY | $58.16 | $58.16 – $58.16 | 949 | 1 |
| Needville, TX | $36.62 | $30.96 – $36.88 | 948 | 2 |
| Guilford, VT | $55.26 | $55.26 – $55.26 | 948 | 1 |
| Covinton, LA | $4.15 | $4.15 – $4.15 | 947 | 1 |
| Arlington, OR | $22.61 | $22.61 – $22.61 | 947 | 1 |
| Peach Springs, AZ | $70.94 | $70.94 – $70.94 | 946 | 1 |
| Munford, AL | $32.45 | $20.33 – $37.29 | 946 | 2 |
| Daufuskie Island, SC | $22.30 | $22.30 – $22.30 | 945 | 1 |
| East Bend, NC | $48.65 | $48.65 – $48.65 | 945 | 1 |
| Hackensack, MN | $71.48 | $71.48 – $71.48 | 945 | 1 |
| South Weumouth, MA | $45.06 | $45.06 – $45.06 | 945 | 1 |
| Blue Mounds, WI | $14.06 | $13.94 – $14.14 | 944 | 2 |
| Gray, GA | $64.72 | $8.26 – $75.58 | 944 | 4 |
| Beaumont, MS | $39.91 | $8.35 – $90.16 | 942 | 3 |
| Hastings, FL | $52.98 | $52.98 – $52.98 | 942 | 1 |
| Mathis, TX | $62.87 | $24.48 – $66.40 | 942 | 3 |
| Sharon Hill, PA | $30.46 | $14.56 – $58.82 | 942 | 4 |
| Bath, PA | $42.96 | $38.47 – $45.78 | 941 | 3 |
| Carlton, WA | $33.20 | $33.20 – $33.20 | 940 | 1 |
| Bismarck, MO | $71.27 | $71.27 – $71.27 | 940 | 1 |
| Lacrosse, WI | $68.12 | $17.57 – $106.33 | 940 | 3 |
| Lynch Station, VA | $55.71 | $55.71 – $55.71 | 940 | 1 |
| Roselle, IL | $69.67 | $36.00 – $102.05 | 938 | 4 |
| Dresher, PA | $37.16 | $37.16 – $37.16 | 937 | 1 |
| Franklin, TX | $89.24 | $89.24 – $89.24 | 937 | 1 |
| Lodi, WI | $30.24 | $24.28 – $46.68 | 937 | 7 |
| Indi, IN | $49.49 | $49.49 – $49.49 | 934 | 1 |
| Marvell, AR | $31.80 | $31.57 – $32.43 | 934 | 2 |
| Walnut, IL | $72.03 | $72.03 – $72.03 | 933 | 1 |
| Hobson City, AL | $12.41 | $12.41 – $12.41 | 932 | 1 |
| Britton, SD | $77.44 | $77.44 – $77.44 | 932 | 1 |
| Crosslake, MN | $55.44 | $49.47 – $98.24 | 932 | 2 |
| Shubuta, MS | $62.92 | $11.95 – $80.78 | 931 | 4 |
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.