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 |
|---|---|---|---|---|
| Plymouth, IA | $52.61 | $52.61 – $52.61 | 636 | 1 |
| Scottville, MI | $64.06 | $50.65 – $65.69 | 635 | 2 |
| Claysburg, PA | $0.00 | $0.00 – $0.00 | 635 | 1 |
| Rockmart, GA | $33.44 | $33.44 – $33.44 | 635 | 1 |
| Horton, AL | $0.00 | $0.00 – $0.00 | 635 | 1 |
| Arivaca, AZ | $0.00 | $0.00 – $0.00 | 635 | 1 |
| Canaan, IN | $22.64 | $22.64 – $22.64 | 634 | 1 |
| Mapleton, UT | $53.57 | $44.10 – $62.78 | 633 | 2 |
| Lakeview, SC | $81.95 | $81.95 – $81.95 | 633 | 1 |
| Macomb Twnp, MI | $67.03 | $67.03 – $67.03 | 633 | 1 |
| Springfield Twsp, OH | $51.70 | $51.70 – $51.70 | 633 | 1 |
| Ledgewood, NJ | $30.41 | $7.60 – $48.76 | 632 | 5 |
| Kivalina, AK | $186.66 | $48.32 – $314.07 | 632 | 2 |
| Niagara Falls, NV | $143.59 | $143.59 – $143.59 | 631 | 1 |
| Land O Lakes, WI | $25.21 | $25.21 – $25.21 | 631 | 1 |
| Elk Grove Vlg, IL | $11.14 | $11.14 – $11.14 | 631 | 1 |
| Mooresboro, NC | $30.46 | $3.94 – $49.83 | 630 | 3 |
| Richland, NJ | $16.36 | $16.36 – $16.36 | 630 | 1 |
| El Prado, NM | $103.12 | $103.12 – $103.12 | 630 | 1 |
| Albrightsville, PA | $39.32 | $36.76 – $42.38 | 629 | 3 |
| Riverton, KS | $20.74 | $0.00 – $34.15 | 629 | 3 |
| Mimbres, NM | $281.41 | $70.76 – $298.08 | 627 | 2 |
| Moody, TX | $35.67 | $35.67 – $35.67 | 627 | 1 |
| Port Hope, MI | $0.29 | $0.29 – $0.29 | 627 | 1 |
| Trimble, MO | $24.87 | $24.87 – $24.87 | 626 | 1 |
| Hurley, VA | $63.57 | $7.28 – $75.17 | 626 | 2 |
| San Jose, Saipan, MP | $170.67 | $170.67 – $170.67 | 626 | 1 |
| Sharpsville, IN | $61.87 | $61.87 – $61.87 | 626 | 1 |
| Buellton, CA | $35.58 | $6.81 – $38.16 | 625 | 3 |
| Mayville, ND | $75.88 | $75.57 – $75.94 | 625 | 2 |
| Eureka, NV | $44.81 | $44.81 – $44.81 | 625 | 1 |
| Lake Tapps, WA | $53.20 | $28.15 – $99.44 | 624 | 3 |
| Broadus, MT | $78.70 | $70.06 – $81.32 | 623 | 2 |
| Brooklyn Hts, OH | $32.91 | $32.91 – $32.91 | 623 | 1 |
| Stickney, IL | $28.95 | $20.96 – $35.47 | 623 | 3 |
| Cincinanti, OH | $60.26 | $60.26 – $60.26 | 623 | 1 |
| Kearns, UT | $51.51 | $16.57 – $58.43 | 623 | 2 |
| Gould, AR | $26.25 | $1.48 – $46.54 | 622 | 2 |
| Pgh, PA | $31.75 | $31.75 – $31.75 | 622 | 1 |
| Philadelphia, Pa, PA | $103.41 | $103.41 – $103.41 | 622 | 1 |
| 3 Fl, NY | $121.23 | $121.23 – $121.23 | 621 | 1 |
| Jeffersonvlle, IN | $55.49 | $51.31 – $56.98 | 620 | 2 |
| Sugarcreek, OH | $40.58 | $32.53 – $42.61 | 620 | 2 |
| Murdo, SD | $123.27 | $123.27 – $123.27 | 619 | 1 |
| Lale, HI | $20.70 | $20.70 – $20.70 | 619 | 1 |
| Ballinger, TX | $21.11 | $21.11 – $21.11 | 619 | 1 |
| Plymouth, CT | $20.06 | $3.67 – $34.32 | 619 | 2 |
| Ardmore, AL | $33.28 | $33.28 – $33.28 | 619 | 1 |
| Homer City, PA | $13.59 | $0.09 – $40.29 | 619 | 2 |
| Campbellsport, WI | $26.11 | $24.21 – $26.56 | 618 | 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.