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 |
|---|---|---|---|---|
| Northumberland, PA | $52.27 | $44.93 – $59.87 | 617 | 2 |
| Eddy, TX | $110.09 | $110.09 – $110.09 | 617 | 1 |
| Middletown, IN | $72.43 | $69.95 – $89.03 | 616 | 2 |
| Mannington Township, NJ | $100.16 | $100.16 – $100.16 | 615 | 1 |
| Rushville, NE | $76.35 | $76.35 – $76.35 | 615 | 1 |
| San Antonio, FL | $15.34 | $8.00 – $50.61 | 614 | 3 |
| Giltner, NE | $44.05 | $44.05 – $44.05 | 613 | 1 |
| Washington Courthouse, OH | $31.37 | $31.37 – $31.37 | 613 | 1 |
| Las Animas, CO | $81.83 | $81.83 – $81.83 | 613 | 1 |
| Gaylord, MN | $60.08 | $52.55 – $66.46 | 612 | 2 |
| Grover Beach, CA | $907.39 | $0.00 – $979.41 | 612 | 2 |
| Glenwood City, WI | $18.25 | $15.44 – $19.28 | 612 | 3 |
| Grover, MO | $49.22 | $49.22 – $49.22 | 611 | 1 |
| Foley, MN | $86.03 | $86.03 – $86.03 | 610 | 1 |
| Crystal Beach, FL | $34.65 | $34.65 – $34.65 | 610 | 1 |
| Eudora, KS | $26.90 | $26.64 – $29.35 | 609 | 2 |
| Hartshorne, OK | $569.33 | $91.22 – $656.59 | 609 | 2 |
| Battlefield, MO | $119.15 | $54.57 – $120.67 | 608 | 2 |
| Lynwood, WA | $40.17 | $40.17 – $40.17 | 608 | 1 |
| Durand, IL | $60.03 | $49.89 – $63.17 | 608 | 3 |
| Lake View Terrace, CA | $584.09 | $584.09 – $584.09 | 608 | 1 |
| March Air Reserve Base, CA | $34.07 | $34.07 – $34.07 | 607 | 1 |
| Mt Morris, PA | $4.85 | $0.00 – $147.23 | 607 | 2 |
| Ashton, ID | $64.70 | $63.99 – $66.25 | 606 | 2 |
| Coon Rapid, MN | $88.42 | $88.42 – $88.42 | 606 | 1 |
| Winneconne, WI | $17.29 | $17.29 – $17.29 | 605 | 1 |
| Eagle Lake, TX | $107.60 | $14.85 – $121.87 | 605 | 3 |
| Lido Beach, NY | $118.84 | $118.84 – $118.84 | 604 | 1 |
| North, SC | $67.01 | $67.01 – $67.01 | 604 | 1 |
| West Windsor, NJ | $57.02 | $43.55 – $73.98 | 604 | 5 |
| Lamoni, IA | $3.14 | $0.00 – $56.57 | 603 | 3 |
| Nelson, NH | $43.26 | $43.26 – $43.26 | 602 | 1 |
| Evaston, IL | $44.32 | $44.32 – $44.32 | 601 | 1 |
| Park Ridge, NJ | $36.18 | $5.77 – $44.90 | 601 | 3 |
| Clio, AL | $45.20 | $45.20 – $45.20 | 600 | 1 |
| So Portland, ME | $45.10 | $45.10 – $45.10 | 600 | 1 |
| West Liberty, WV | $25.13 | $25.13 – $25.13 | 599 | 1 |
| Montevallo, AL | $40.42 | $0.00 – $76.82 | 598 | 4 |
| Fort Washingtion, MD | $27.91 | $27.91 – $27.91 | 598 | 1 |
| Beaver Falls, NY | $66.21 | $65.70 – $67.83 | 597 | 2 |
| Smithville, TX | $2.72 | $2.72 – $2.72 | 597 | 1 |
| Duchesne, UT | $95.79 | $95.79 – $95.79 | 595 | 1 |
| Perth, NY | $68.96 | $56.34 – $91.75 | 595 | 2 |
| Beatty, NV | $157.41 | $157.41 – $157.41 | 595 | 1 |
| El Monte, AL | $0.00 | $0.00 – $0.00 | 594 | 1 |
| Velva, ND | $77.28 | $76.09 – $77.66 | 594 | 2 |
| Calhoun Falls, SC | $168.48 | $168.48 – $168.48 | 594 | 1 |
| Brady, TX | $15.61 | $11.51 – $15.75 | 593 | 2 |
| Bowling Green, SC | $68.80 | $68.80 – $68.80 | 592 | 1 |
| Wake Village, TX | $41.56 | $10.09 – $70.54 | 592 | 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.