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 |
|---|---|---|---|---|
| Elmira Heights, NY | $37.00 | $37.00 – $37.00 | 765 | 1 |
| Cohutta, GA | $35.30 | $35.30 – $35.30 | 763 | 1 |
| Wyalusing, PA | $77.50 | $77.50 – $77.50 | 762 | 1 |
| Hallsville, TX | $34.21 | $0.00 – $38.76 | 762 | 3 |
| Westmoreland, KS | $23.94 | $20.75 – $29.03 | 762 | 3 |
| Kearney, MO | $43.21 | $25.74 – $70.37 | 762 | 5 |
| Gordon, GA | $100.24 | $87.40 – $114.14 | 760 | 2 |
| Santo Domingo, NM | $14.72 | $13.97 – $14.73 | 758 | 2 |
| Morrison, CO | $100.37 | $44.72 – $176.23 | 758 | 3 |
| Notre Dame, IN | $46.37 | $38.56 – $60.29 | 757 | 2 |
| Littlefield, TX | $18.42 | $0.00 – $22.50 | 756 | 3 |
| Cosmopolis, WA | $71.07 | $71.07 – $71.07 | 756 | 1 |
| Millwood, WV | $76.45 | $76.45 – $76.45 | 756 | 1 |
| Ironton, MO | $16.30 | $16.30 – $16.30 | 756 | 1 |
| Edisto Island, SC | $22.44 | $22.44 – $22.44 | 756 | 1 |
| Patrick Afb, FL | $19.20 | $0.83 – $22.21 | 755 | 2 |
| Monterey, VA | $49.63 | $26.58 – $59.92 | 754 | 5 |
| Hudson, MI | $59.83 | $59.83 – $59.83 | 754 | 1 |
| Mendon, IL | $93.28 | $93.28 – $93.28 | 753 | 1 |
| Eads, TN | $12.47 | $12.47 – $12.47 | 753 | 1 |
| Parowan, UT | $58.14 | $44.70 – $78.65 | 752 | 3 |
| Brockton, MT | $80.79 | $80.79 – $80.79 | 751 | 1 |
| Blue River, OR | $13.31 | $13.31 – $13.31 | 751 | 1 |
| Mineola, TX | $39.83 | $30.02 – $69.93 | 750 | 5 |
| Ft Warren Afb, WY | $59.45 | $59.45 – $59.45 | 750 | 1 |
| Lower Gwynedd, PA | $47.91 | $24.63 – $72.65 | 749 | 5 |
| Creighton, PA | $47.95 | $47.95 – $47.95 | 749 | 1 |
| Tusla, OK | $91.59 | $91.59 – $91.59 | 749 | 1 |
| Monticello, MO | $16.62 | $16.62 – $16.62 | 749 | 1 |
| Elizabethville, PA | $34.12 | $34.12 – $34.12 | 749 | 1 |
| Hungtington Park, CA | $0.00 | $0.00 – $0.00 | 749 | 1 |
| Mine Hill, NJ | $18.65 | $5.49 – $34.35 | 748 | 2 |
| Jb Mdl, NJ | $51.26 | $30.88 – $61.45 | 747 | 4 |
| Continental, OH | $38.25 | $38.25 – $38.25 | 747 | 1 |
| East Norristown, PA | $38.34 | $38.34 – $38.34 | 746 | 1 |
| Cainsville, MO | $75.91 | $68.76 – $103.77 | 744 | 2 |
| South Bound Brook, NJ | $63.00 | $63.00 – $63.00 | 744 | 1 |
| Camden, IN | $51.80 | $51.80 – $51.80 | 743 | 1 |
| Dupont, WA | $38.94 | $2.26 – $62.29 | 742 | 3 |
| Froestville, NY | $61.69 | $61.69 – $61.69 | 742 | 1 |
| Allendale, NJ | $38.30 | $38.30 – $38.30 | 741 | 1 |
| New Hope, AL | $61.18 | $58.61 – $66.74 | 740 | 2 |
| Represa, CA | $1.61 | $1.61 – $1.61 | 740 | 1 |
| Merion Station, PA | $44.44 | $44.44 – $44.44 | 739 | 1 |
| Ferendale, CA | $9.20 | $9.20 – $9.20 | 739 | 1 |
| Allison, IA | $5.73 | $0.60 – $6.32 | 739 | 2 |
| Holland, NY | $44.20 | $44.20 – $44.20 | 738 | 1 |
| Kermit, TX | $34.70 | $34.28 – $55.06 | 738 | 2 |
| Bartlett, NE | $62.46 | $62.46 – $62.46 | 738 | 1 |
| Whiteville, TN | $42.15 | $30.02 – $48.66 | 736 | 2 |
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.