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 |
|---|---|---|---|---|
| Koliganek, AK | $343.91 | $177.21 – $366.68 | 516 | 2 |
| Fresno, OH | $41.14 | $41.14 – $41.14 | 515 | 1 |
| Oakland, FL | $17.85 | $11.61 – $21.91 | 515 | 2 |
| Nesquehoning, PA | $44.57 | $44.57 – $44.57 | 515 | 1 |
| Raven, VA | $66.57 | $66.57 – $66.57 | 514 | 1 |
| Athens, WI | $46.28 | $46.28 – $46.28 | 514 | 1 |
| Rllng Hls Est, CA | $19.53 | $19.53 – $19.53 | 513 | 1 |
| Rome, OH | $0.00 | $0.00 – $0.00 | 513 | 1 |
| San Quentin, CA | $94.55 | $94.55 – $94.55 | 513 | 1 |
| Carlisle, AR | $16.58 | $0.00 – $42.19 | 513 | 4 |
| Caraway, AR | $25.08 | $24.43 – $25.38 | 512 | 2 |
| Brimfield, IL | $66.60 | $64.72 – $67.19 | 511 | 2 |
| West Stockbridge, MA | $40.46 | $40.46 – $40.46 | 511 | 1 |
| Wales, WI | $30.46 | $18.20 – $31.15 | 510 | 2 |
| Omega, GA | $55.04 | $55.04 – $55.04 | 510 | 1 |
| Elmore, OH | $41.16 | $39.80 – $58.56 | 510 | 2 |
| Rancho Santa Fe, CA | $18.94 | $18.94 – $18.94 | 510 | 1 |
| Mount Gilead, NC | $43.52 | $35.67 – $44.01 | 510 | 2 |
| Princeville, HI | $54.31 | $3.46 – $58.88 | 509 | 2 |
| Mannington, WV | $44.82 | $0.00 – $56.18 | 509 | 3 |
| Earlington, KY | $30.63 | $30.63 – $30.63 | 507 | 1 |
| Preston, MN | $48.73 | $41.87 – $57.48 | 507 | 3 |
| So Berwick, ME | $29.79 | $29.79 – $29.79 | 507 | 1 |
| Holland, MA | $55.29 | $55.29 – $55.29 | 507 | 1 |
| White Sands Missile Range, NM | $181.68 | $181.68 – $181.68 | 507 | 1 |
| Zumbrota, MN | $42.07 | $42.07 – $42.07 | 506 | 1 |
| Mt Airy, MD | $89.71 | $89.71 – $89.71 | 506 | 1 |
| Bainbridge, NY | $47.44 | $47.44 – $47.44 | 506 | 1 |
| Waddington, NY | $55.45 | $55.45 – $55.45 | 505 | 1 |
| Gibbon, NE | $204.28 | $204.28 – $204.28 | 505 | 1 |
| Emmonak, AK | $6.54 | $0.00 – $12.49 | 504 | 2 |
| Tower, MN | $247.90 | $247.90 – $247.90 | 503 | 1 |
| Jordan, AR | $34.41 | $34.41 – $34.41 | 502 | 1 |
| Farmington, NH | $13.60 | $12.40 – $58.68 | 502 | 2 |
| Farwell, TX | $85.77 | $81.19 – $117.09 | 502 | 2 |
| Byesville, OH | $81.25 | $81.25 – $81.25 | 502 | 1 |
| Wlks Barr Twp, PA | $49.39 | $49.39 – $49.39 | 501 | 1 |
| Highland, KS | $131.05 | $131.05 – $131.05 | 501 | 1 |
| West Fork, AR | $43.70 | $43.70 – $43.70 | 500 | 1 |
| Cable, WI | $43.76 | $43.76 – $43.76 | 500 | 1 |
| Mize, MS | $223.03 | $223.03 – $223.03 | 499 | 1 |
| South Barre, VT | $13.95 | $13.95 – $13.95 | 498 | 1 |
| Ft Sam Houston, TX | $28.67 | $28.67 – $28.67 | 497 | 1 |
| Red Oak, OK | $50.32 | $50.32 – $50.32 | 497 | 1 |
| Prichard, AL | $0.00 | $0.00 – $0.00 | 496 | 1 |
| Pacific Grove, CA | $85.20 | $85.20 – $85.20 | 495 | 1 |
| Canaan, NY | $190.77 | $190.77 – $190.77 | 493 | 1 |
| Crosby, ND | $101.22 | $49.81 – $139.38 | 493 | 3 |
| Fort Nill, SC | $62.11 | $62.11 – $62.11 | 492 | 1 |
| Clymer, PA | $40.70 | $30.85 – $57.15 | 492 | 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.