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 |
|---|---|---|---|---|
| Plains, GA | $16.63 | $16.63 – $16.63 | 565 | 1 |
| Edgartown, MA | $138.99 | $25.72 – $198.61 | 564 | 4 |
| Germantown, IL | $0.00 | $0.00 – $0.00 | 564 | 1 |
| Dover, MA | $43.61 | $43.61 – $43.61 | 564 | 1 |
| Misissippi State University, MS | $43.25 | $43.25 – $43.25 | 564 | 1 |
| Redfield, AR | $23.89 | $23.89 – $23.89 | 563 | 1 |
| Clear Lake, MN | $73.39 | $68.91 – $115.66 | 563 | 2 |
| Gilbert, PA | $48.41 | $48.41 – $48.41 | 562 | 1 |
| Parker, SD | $75.87 | $39.71 – $82.24 | 561 | 2 |
| Redlandss, CA | $79.89 | $79.89 – $79.89 | 561 | 1 |
| Hickory, PA | $35.82 | $33.45 – $36.64 | 561 | 3 |
| Shelley, ID | $9.35 | $3.51 – $134.71 | 561 | 2 |
| Yeagertown, PA | $16.95 | $16.95 – $16.95 | 560 | 1 |
| Friant, CA | $16.95 | $12.07 – $66.76 | 560 | 2 |
| Naylor, MO | $75.96 | $75.96 – $75.96 | 560 | 1 |
| Windham, OH | $37.72 | $37.72 – $37.72 | 560 | 1 |
| Black Hawk, SD | $59.87 | $59.87 – $59.87 | 560 | 1 |
| Chillicothe, TX | $142.42 | $142.42 – $142.42 | 560 | 1 |
| Valley Park, MO | $75.34 | $75.34 – $75.34 | 559 | 1 |
| Monkton, MD | $83.22 | $83.22 – $83.22 | 559 | 1 |
| Lavalette, WV | $50.39 | $50.01 – $65.11 | 558 | 2 |
| Boston, KY | $61.76 | $61.76 – $61.76 | 558 | 1 |
| Tiburon, CA | $35.41 | $35.41 – $35.41 | 557 | 1 |
| Union Pier, MI | $15.20 | $15.20 – $15.20 | 554 | 1 |
| Castro Valley 94546, CA | $65.02 | $65.02 – $65.02 | 553 | 1 |
| Goodwater, AL | $0.00 | $0.00 – $0.00 | 553 | 2 |
| Madison, IL | $92.31 | $92.31 – $92.31 | 552 | 1 |
| Silver Lake, OR | $89.04 | $89.04 – $89.04 | 552 | 1 |
| Gettysburg, SD | $66.68 | $23.21 – $110.54 | 552 | 3 |
| Womelsdorf, PA | $38.56 | $36.54 – $52.64 | 551 | 2 |
| Tinker Afb, OK | $66.95 | $66.95 – $66.95 | 551 | 1 |
| Southwick, MA | $51.79 | $51.79 – $51.79 | 551 | 1 |
| Brunswick, MD | $100.06 | $48.18 – $125.55 | 550 | 4 |
| Valley Falls, KS | $53.79 | $15.75 – $218.21 | 550 | 4 |
| Shady Spring, WV | $35.82 | $21.26 – $38.56 | 549 | 2 |
| Cross Plains, WI | $28.08 | $12.89 – $40.41 | 549 | 6 |
| Burnsville, MS | $42.39 | $11.23 – $54.56 | 549 | 4 |
| Ft. Oglethorpe, GA | $14.98 | $14.98 – $14.98 | 548 | 1 |
| Alfred, NY | $70.82 | $70.82 – $70.82 | 548 | 1 |
| Constantine, MI | $42.41 | $42.41 – $42.41 | 547 | 1 |
| Emerson, NE | $128.14 | $128.14 – $128.14 | 546 | 1 |
| Hewitt, TX | $45.73 | $4.53 – $52.63 | 546 | 4 |
| Fairway, KS | $27.99 | $27.99 – $27.99 | 545 | 1 |
| Astoria, IL | $0.09 | $0.09 – $0.09 | 544 | 1 |
| Atlantic Beach, FL | $86.84 | $86.84 – $86.84 | 544 | 1 |
| Kailuakona, HI | $32.83 | $32.83 – $32.83 | 544 | 1 |
| Fairchild Air Force Base, WA | $38.12 | $38.12 – $38.12 | 543 | 1 |
| St John, ND | $539.34 | $539.34 – $539.34 | 543 | 1 |
| Lagrange, ME | $43.16 | $43.16 – $43.16 | 541 | 1 |
| Clio, SC | $39.40 | $39.40 – $39.40 | 541 | 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.