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 |
|---|---|---|---|---|
| Sarcoxie, MO | $24.63 | $24.63 – $24.63 | 862 | 1 |
| Centralia, KS | $135.44 | $135.44 – $135.44 | 861 | 1 |
| Columbus Junction, IA | $1.04 | $0.00 – $15.49 | 860 | 2 |
| Haverhill, NH | $38.29 | $38.29 – $38.29 | 860 | 1 |
| Sarver, PA | $7.38 | $0.00 – $53.69 | 859 | 2 |
| Muleshoe, TX | $60.49 | $0.00 – $167.55 | 858 | 6 |
| New Stuyahok, AK | $360.05 | $29.44 – $366.34 | 857 | 2 |
| Congress, AZ | $0.90 | $0.90 – $0.90 | 855 | 1 |
| Horseshoe Bay, TX | $47.62 | $45.33 – $54.92 | 855 | 2 |
| South Glastonbury, CT | $24.77 | $24.77 – $24.77 | 854 | 1 |
| Heuvelton, NY | $48.64 | $48.64 – $48.64 | 854 | 1 |
| Los Osos, CA | $38.27 | $38.27 – $38.27 | 853 | 1 |
| Lidgerwood, ND | $74.26 | $74.26 – $74.26 | 851 | 1 |
| Northwood, OH | $62.19 | $62.19 – $62.19 | 851 | 1 |
| Pelham, NY | $71.50 | $71.50 – $71.50 | 850 | 1 |
| Morenci, MI | $33.27 | $33.27 – $33.27 | 850 | 1 |
| Surfside, FL | $8.90 | $0.65 – $112.65 | 850 | 3 |
| Theodosia, MO | $4.28 | $4.28 – $4.28 | 850 | 1 |
| Savannah, MO | $74.00 | $35.98 – $82.12 | 847 | 2 |
| Frederickburg, VA | $48.99 | $21.62 – $49.55 | 847 | 2 |
| Aberdeen, OH | $56.44 | $56.44 – $56.44 | 847 | 1 |
| Paia, HI | $68.19 | $68.19 – $68.19 | 846 | 1 |
| Ione, CA | $23.99 | $0.42 – $37.98 | 844 | 4 |
| Saxton, PA | $52.56 | $52.56 – $52.56 | 843 | 1 |
| Dermott, AR | $5.00 | $0.00 – $17.97 | 843 | 8 |
| Sunbright, TN | $50.85 | $50.85 – $50.85 | 843 | 1 |
| Karnes City, TX | $42.28 | $38.47 – $45.47 | 842 | 3 |
| Flora, MS | $0.52 | $0.00 – $33.43 | 842 | 2 |
| Collegeville, MN | $56.52 | $56.52 – $56.52 | 841 | 1 |
| Kings Park, NY | $49.96 | $41.45 – $85.08 | 841 | 2 |
| Hyde Park, VT | $114.18 | $114.18 – $114.18 | 840 | 1 |
| West Barnstable, MA | $41.77 | $41.77 – $41.77 | 840 | 1 |
| Woolwich Twp, NJ | $41.63 | $41.63 – $41.63 | 839 | 1 |
| Deer Park, IL | $6.80 | $3.37 – $40.28 | 838 | 2 |
| Somerset, WI | $31.23 | $12.91 – $36.00 | 836 | 4 |
| Norris City, IL | $46.54 | $46.54 – $46.54 | 836 | 1 |
| Joint Base Elmendorf Richardson, AK | $60.37 | $60.37 – $60.37 | 836 | 1 |
| Goodnews Bay, AK | $310.56 | $310.56 – $310.56 | 836 | 1 |
| Gunnision, MS | $23.76 | $23.76 – $23.76 | 835 | 1 |
| Eaton Center, NH | $39.59 | $39.59 – $39.59 | 834 | 1 |
| Bayville, NY | $68.61 | $68.61 – $68.61 | 834 | 1 |
| Santee, SC | $63.96 | $3.08 – $64.92 | 833 | 2 |
| Virginia, VA | $47.74 | $47.74 – $47.74 | 831 | 1 |
| Waynesburg, KY | $18.03 | $18.03 – $18.03 | 831 | 1 |
| Sandy Creek, NY | $83.10 | $83.10 – $83.10 | 830 | 1 |
| Thorntown, IN | $76.25 | $31.61 – $79.36 | 829 | 2 |
| Central Valley, PA | $50.98 | $50.98 – $50.98 | 828 | 1 |
| River Grove, IL | $49.91 | $45.89 – $54.40 | 828 | 2 |
| N Ogden, UT | $29.21 | $29.21 – $29.21 | 825 | 1 |
| Blue Rapids, KS | $98.32 | $31.53 – $109.23 | 825 | 3 |
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.