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 |
|---|---|---|---|---|
| Wood Dale, IL | $55.73 | $55.73 – $55.73 | 898 | 1 |
| Sheridan, IL | $62.11 | $62.11 – $62.11 | 898 | 1 |
| Stockdale, TX | $26.25 | $11.32 – $32.98 | 898 | 2 |
| West Valley, NY | $49.01 | $49.01 – $49.01 | 896 | 1 |
| Millville, PA | $41.07 | $41.07 – $41.07 | 896 | 1 |
| Pound Ridge, NY | $112.68 | $112.68 – $112.68 | 895 | 1 |
| St Marys, OH | $31.50 | $29.31 – $33.12 | 895 | 2 |
| South Dennis, MA | $93.22 | $49.51 – $99.95 | 893 | 3 |
| Miller City, OH | $50.71 | $50.71 – $50.71 | 892 | 1 |
| Gambell, AK | $401.71 | $347.35 – $427.45 | 891 | 3 |
| Baird, TX | $2.34 | $2.34 – $2.34 | 890 | 1 |
| New Boston, OH | $63.02 | $43.61 – $134.50 | 890 | 3 |
| Colstrip, MT | $95.79 | $91.47 – $101.50 | 890 | 2 |
| Clinton, OH | $20.45 | $0.00 – $21.98 | 889 | 4 |
| Collegedale, TN | $56.63 | $56.63 – $56.63 | 889 | 1 |
| Peshtigo, WI | $35.30 | $24.13 – $39.45 | 889 | 5 |
| Newport, NY | $78.59 | $78.59 – $78.59 | 888 | 1 |
| The Plains, VA | $10.25 | $10.25 – $10.25 | 888 | 1 |
| Mc Clellanville, SC | $57.38 | $40.87 – $132.92 | 887 | 3 |
| Buffalo, WY | $29.68 | $3.27 – $58.56 | 885 | 6 |
| Inverness, IL | $62.68 | $51.93 – $88.19 | 885 | 3 |
| Grantville, GA | $94.63 | $54.38 – $116.65 | 885 | 2 |
| Pompano Bch, FL | $60.75 | $60.75 – $60.75 | 884 | 1 |
| Keatchie, LA | $49.10 | $49.10 – $49.10 | 884 | 1 |
| Boxford, MA | $29.85 | $29.61 – $34.15 | 882 | 2 |
| Allendale, SC | $70.55 | $0.00 – $79.18 | 882 | 3 |
| Noatak, AK | $49.75 | $0.00 – $75.96 | 881 | 4 |
| New York Mills, MN | $49.86 | $49.86 – $49.86 | 881 | 1 |
| Oakfield, TN | $37.02 | $37.02 – $37.02 | 881 | 1 |
| Dysart, PA | $57.93 | $57.93 – $57.93 | 880 | 1 |
| Battle Mountain, NV | $46.00 | $0.53 – $78.35 | 880 | 3 |
| Argillite, KY | $28.00 | $28.00 – $28.00 | 880 | 1 |
| Milford, NE | $113.22 | $111.60 – $120.73 | 879 | 2 |
| Trevor, WI | $22.75 | $22.75 – $22.75 | 877 | 1 |
| Fish Camp, CA | $2.94 | $2.94 – $2.94 | 877 | 1 |
| Roland, OK | $33.17 | $0.00 – $125.64 | 877 | 5 |
| Ocean Grove, NJ | $66.28 | $1.31 – $84.40 | 876 | 2 |
| Duryea, PA | $41.09 | $9.53 – $43.34 | 874 | 3 |
| Glenrock, WY | $10.00 | $1.80 – $65.72 | 873 | 2 |
| Sublette, KS | $101.04 | $76.14 – $120.24 | 872 | 3 |
| Forestdale, AL | $45.19 | $45.19 – $45.19 | 871 | 1 |
| Sebeka, MN | $185.42 | $185.42 – $185.42 | 870 | 1 |
| Chapman, NE | $202.50 | $202.50 – $202.50 | 869 | 1 |
| East Meadows, NY | $112.81 | $112.81 – $112.81 | 868 | 1 |
| New Lebanon, OH | $47.22 | $42.70 – $54.55 | 868 | 3 |
| Linden, TX | $33.51 | $32.02 – $36.38 | 867 | 2 |
| Lindstrom, MN | $86.62 | $62.62 – $118.04 | 866 | 2 |
| Lyndeborough, NH | $0.80 | $0.80 – $0.80 | 865 | 1 |
| Sommers Point, NJ | $53.98 | $52.92 – $55.80 | 864 | 2 |
| Sarcoxie, MO | $24.63 | $24.63 – $24.63 | 862 | 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.