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 |
|---|---|---|---|---|
| Castle Hills, TX | $28.50 | $6.47 – $134.58 | 668 | 4 |
| Rainier, WA | $80.06 | $80.06 – $80.06 | 667 | 1 |
| Lexington, IN | $121.11 | $121.11 – $121.11 | 667 | 1 |
| Pueblo Of Acoma, NM | $164.95 | $164.95 – $164.95 | 666 | 1 |
| Dunsmuir, CA | $1.54 | $1.54 – $1.54 | 666 | 1 |
| Perrysville, OH | $67.89 | $67.89 – $67.89 | 664 | 1 |
| Selma, OR | $1.73 | $1.73 – $1.73 | 664 | 1 |
| Spring Grove, MN | $53.37 | $45.17 – $54.65 | 664 | 3 |
| Ninole, HI | $34.39 | $34.39 – $34.39 | 663 | 1 |
| Batesburg, SC | $16.34 | $16.34 – $16.34 | 662 | 1 |
| Hooper Bay, AK | $126.67 | $0.00 – $442.39 | 661 | 4 |
| Randolph, WI | $33.68 | $33.68 – $33.68 | 659 | 1 |
| Taylor, AZ | $48.15 | $48.15 – $48.15 | 659 | 1 |
| Rancho Mission Viejo, CA | $16.39 | $16.39 – $16.39 | 659 | 1 |
| Hawthorne, NV | $0.00 | $0.00 – $0.00 | 658 | 1 |
| Shapiro 9, Suite A, MA | $36.29 | $36.29 – $36.29 | 658 | 1 |
| Cardiff By The Sea, CA | $22.06 | $6.75 – $127.92 | 657 | 2 |
| Greenbush, MN | $49.69 | $49.69 – $49.69 | 657 | 1 |
| South Attlevoro, MA | $52.69 | $52.69 – $52.69 | 656 | 1 |
| Wilber, NE | $101.78 | $101.78 – $101.78 | 656 | 1 |
| 1 Jarrett White Road, HI | $275.93 | $275.93 – $275.93 | 655 | 1 |
| Bridgeport, WA | $24.50 | $24.42 – $28.30 | 655 | 2 |
| Portlan, OR | $60.53 | $60.53 – $60.53 | 655 | 1 |
| Stockbridge, MI | $56.02 | $56.02 – $56.02 | 654 | 1 |
| Bokeelia, FL | $47.41 | $47.41 – $47.41 | 653 | 1 |
| Phillipsburg, MT | $106.39 | $106.39 – $106.39 | 653 | 1 |
| Colgate, WI | $26.25 | $26.25 – $26.25 | 652 | 1 |
| Cottonwood Falls, KS | $102.17 | $102.17 – $102.17 | 652 | 1 |
| Medicine Bow, WY | $42.52 | $42.18 – $55.23 | 651 | 2 |
| North Bangor, NY | $84.82 | $84.82 – $84.82 | 651 | 1 |
| Saint Edward, NE | $72.68 | $65.08 – $75.86 | 651 | 2 |
| Port Republic, VA | $53.12 | $37.71 – $60.94 | 650 | 2 |
| Boothwyn, PA | $49.23 | $16.32 – $60.08 | 649 | 2 |
| Cross, SC | $148.64 | $148.64 – $148.64 | 648 | 1 |
| Hebron, IN | $52.22 | $51.28 – $60.90 | 648 | 2 |
| Rolette, ND | $135.57 | $135.57 – $135.57 | 648 | 1 |
| San-Lorenzo, PR | $52.80 | $52.80 – $52.80 | 647 | 1 |
| San Bernrdino, CA | $0.16 | $0.16 – $0.16 | 646 | 1 |
| Quincy, MI | $33.72 | $2.72 – $34.45 | 646 | 2 |
| Sand Point, AK | $346.87 | $0.00 – $425.67 | 644 | 3 |
| Highmore, SD | $97.78 | $97.78 – $97.78 | 643 | 1 |
| Topeka, IN | $42.38 | $28.21 – $89.42 | 643 | 4 |
| Mulberry, AR | $39.09 | $39.09 – $39.09 | 642 | 1 |
| Metamora, OH | $38.31 | $38.31 – $38.31 | 642 | 1 |
| New Braintree, MA | $3.04 | $3.04 – $3.04 | 641 | 1 |
| Ingleside, TX | $59.94 | $59.94 – $59.94 | 639 | 1 |
| Corsica, SD | $83.88 | $83.88 – $83.88 | 637 | 1 |
| Lennox, SD | $63.11 | $63.11 – $63.11 | 637 | 1 |
| Lake Dallas, TX | $34.46 | $34.46 – $34.46 | 636 | 1 |
| Quinlan, TX | $29.61 | $1.83 – $32.73 | 636 | 5 |
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.