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 |
|---|---|---|---|---|
| Mechanic Falls, ME | $38.49 | $38.49 – $38.49 | 823 | 1 |
| Osprey, FL | $44.26 | $9.30 – $51.30 | 822 | 5 |
| Dumas, MS | $47.37 | $47.37 – $47.37 | 821 | 1 |
| North Grafton, MA | $56.66 | $34.59 – $63.78 | 820 | 3 |
| Glendale Luke Afb, AZ | $58.04 | $58.04 – $58.04 | 820 | 1 |
| Trenton, TX | $52.98 | $52.98 – $52.98 | 819 | 1 |
| Cumberland Foreside, ME | $74.43 | $74.43 – $74.43 | 818 | 1 |
| Muldrow, OK | $43.19 | $43.19 – $43.19 | 818 | 1 |
| Portola Valley, CA | $35.25 | $34.71 – $39.13 | 818 | 2 |
| Orwell, VT | $8.18 | $8.18 – $8.18 | 818 | 1 |
| Ely, NV | $18.36 | $0.00 – $427.00 | 817 | 7 |
| Wilson, KS | $28.06 | $28.06 – $28.06 | 817 | 1 |
| Shingletown, CA | $116.67 | $1.05 – $172.35 | 816 | 4 |
| Farmingdale, NJ | $69.13 | $0.68 – $96.90 | 815 | 3 |
| Hutoo, TX | $84.22 | $84.22 – $84.22 | 815 | 1 |
| Wyoming, IL | $0.46 | $0.46 – $0.46 | 814 | 1 |
| New Bethlehem, PA | $0.00 | $0.00 – $0.00 | 814 | 1 |
| Newbury, VT | $86.38 | $86.38 – $86.38 | 812 | 1 |
| Waitsfield, VT | $24.22 | $23.27 – $74.72 | 811 | 2 |
| Huntington Mills, PA | $24.42 | $24.42 – $24.42 | 811 | 1 |
| Corrales, NM | $70.01 | $40.26 – $253.60 | 810 | 4 |
| Hauula, HI | $33.47 | $0.00 – $37.24 | 810 | 2 |
| Thomas, WV | $21.35 | $21.35 – $21.35 | 809 | 1 |
| Ft. Novosel, AL | $39.06 | $39.06 – $39.06 | 807 | 1 |
| Caseville, MI | $13.68 | $13.68 – $13.68 | 807 | 1 |
| Au Sable Forks, NY | $67.94 | $45.75 – $71.22 | 807 | 2 |
| Montgomery, PA | $42.39 | $42.39 – $42.39 | 806 | 1 |
| Tuckerton, NJ | $59.66 | $59.66 – $59.66 | 805 | 1 |
| Nauvoo, IL | $0.00 | $0.00 – $0.00 | 804 | 1 |
| Kemmerer, WY | $24.78 | $0.00 – $62.27 | 804 | 4 |
| Columbia, NC | $0.68 | $0.68 – $0.68 | 803 | 1 |
| River Vale, NJ | $64.00 | $0.00 – $69.74 | 803 | 4 |
| Forest City Specialtly Family, FL | $44.50 | $44.50 – $44.50 | 802 | 1 |
| Roseville, OH | $30.07 | $28.99 – $39.43 | 802 | 2 |
| Charlton, NY | $58.61 | $35.28 – $59.96 | 801 | 3 |
| Burwell, NE | $126.29 | $106.07 – $140.81 | 800 | 3 |
| Henrietta, TX | $36.43 | $35.29 – $100.32 | 799 | 2 |
| Bladenboro, NC | $29.53 | $0.00 – $53.26 | 799 | 5 |
| Hudson, IA | $30.81 | $30.81 – $30.81 | 799 | 1 |
| Liberty, TX | $27.47 | $2.66 – $32.64 | 799 | 6 |
| Lacenter, KY | $24.59 | $24.59 – $24.59 | 798 | 1 |
| Windsor, MD | $137.75 | $137.75 – $137.75 | 797 | 1 |
| Halstead, KS | $73.20 | $36.21 – $141.51 | 797 | 2 |
| Palouse, WA | $35.89 | $22.59 – $37.25 | 795 | 2 |
| Mentone, CA | $66.47 | $66.47 – $66.47 | 793 | 1 |
| East Sandwich, MA | $31.82 | $25.72 – $58.23 | 793 | 4 |
| Searsport, ME | $47.83 | $47.83 – $47.83 | 793 | 1 |
| Caldwell, TX | $26.06 | $0.00 – $29.47 | 792 | 3 |
| Bay Point, CA | $25.71 | $25.71 – $25.71 | 791 | 1 |
| Beavercreek Township, OH | $23.87 | $23.87 – $23.87 | 791 | 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.