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 |
|---|---|---|---|---|
| Clear Lake, WI | $31.05 | $14.77 – $31.26 | 931 | 2 |
| Dos Palos, CA | $25.66 | $0.00 – $75.00 | 930 | 4 |
| White Oak, TX | $63.70 | $63.70 – $63.70 | 929 | 1 |
| Maxwell, AL | $34.29 | $34.29 – $34.29 | 929 | 1 |
| Crosby, TX | $20.15 | $19.28 – $26.86 | 929 | 2 |
| Swan Quarter, NC | $62.54 | $62.54 – $62.54 | 929 | 1 |
| Sawyerville, AL | $15.39 | $0.00 – $32.09 | 928 | 2 |
| Tunica Resorts, MS | $13.86 | $13.86 – $13.86 | 928 | 1 |
| Burns, TN | $44.19 | $44.19 – $44.19 | 928 | 1 |
| Glendora, NJ | $75.08 | $31.94 – $91.79 | 928 | 4 |
| Golconda, IL | $0.59 | $0.59 – $0.59 | 927 | 1 |
| Cambridge, WI | $32.44 | $7.04 – $36.33 | 926 | 4 |
| Wagon Mound, NM | $147.38 | $147.38 – $147.38 | 925 | 1 |
| Cherry Creek, SD | $606.18 | $606.18 – $606.18 | 925 | 1 |
| Vienna, MO | $43.49 | $43.18 – $56.88 | 924 | 2 |
| Moonachie, NJ | $81.45 | $40.86 – $105.52 | 924 | 2 |
| New Bedform, MA | $66.64 | $66.64 – $66.64 | 924 | 1 |
| Pocola, OK | $2.11 | $2.11 – $2.11 | 924 | 1 |
| College Grove, TN | $53.60 | $53.60 – $53.60 | 924 | 1 |
| Mount Upton, NY | $33.14 | $33.14 – $33.14 | 923 | 1 |
| Graceville, MN | $152.71 | $64.81 – $176.82 | 921 | 4 |
| Bancroft, IA | $0.05 | $0.05 – $0.05 | 921 | 1 |
| Lingle, WY | $67.08 | $67.08 – $67.08 | 919 | 1 |
| Warm Springs, MT | $316.48 | $11.61 – $608.51 | 919 | 3 |
| Ft.Campbell, KY | $70.14 | $70.14 – $70.14 | 919 | 1 |
| Millbrook, NY | $32.30 | $16.57 – $154.76 | 918 | 3 |
| Flemington, WV | $21.88 | $21.88 – $21.88 | 917 | 1 |
| Metairle, LA | $24.82 | $24.82 – $24.82 | 917 | 1 |
| Branchville, SC | $54.73 | $54.73 – $54.73 | 916 | 1 |
| Bagdad, AZ | $39.92 | $39.22 – $41.55 | 914 | 3 |
| Cavalier, ND | $83.04 | $72.59 – $98.41 | 914 | 4 |
| Scheneckedy, NY | $51.06 | $51.06 – $51.06 | 914 | 1 |
| Rosemont, PA | $64.55 | $64.55 – $64.55 | 913 | 1 |
| Salome, AZ | $0.89 | $0.89 – $0.89 | 912 | 1 |
| New Hampton, NH | $35.74 | $35.74 – $35.74 | 912 | 1 |
| Buffalo, OK | $147.44 | $147.00 – $153.93 | 911 | 2 |
| Unicoi, TN | $21.60 | $21.60 – $21.60 | 910 | 1 |
| Left Hand, WV | $32.40 | $32.40 – $32.40 | 910 | 1 |
| Cumberland, ME | $32.80 | $26.06 – $33.56 | 909 | 2 |
| Lineville, IA | $8.76 | $0.76 – $13.14 | 907 | 4 |
| Oradel, NJ | $119.66 | $119.66 – $119.66 | 906 | 1 |
| Atlantic Highlands, NJ | $55.88 | $4.23 – $84.53 | 905 | 5 |
| Cold Spring Harbor, NY | $67.84 | $67.84 – $67.84 | 905 | 1 |
| Duquesne, PA | $48.53 | $48.53 – $48.53 | 903 | 1 |
| Haysville, KS | $92.47 | $15.75 – $125.82 | 902 | 3 |
| Haslet, TX | $110.54 | $41.11 – $415.48 | 901 | 4 |
| Tombstone, AZ | $17.15 | $0.00 – $18.55 | 899 | 2 |
| Frazier Park, CA | $14.01 | $0.27 – $15.10 | 899 | 2 |
| Trenton, IL | $34.90 | $0.00 – $39.86 | 899 | 3 |
| Livermore, CO | $30.13 | $30.13 – $30.13 | 899 | 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.