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 |
|---|---|---|---|---|
| Sugar Hill, GA | $175.64 | $175.64 – $175.64 | 441 | 1 |
| Fulda, MN | $218.45 | $218.45 – $218.45 | 441 | 1 |
| Heflin, LA | $20.37 | $20.37 – $20.37 | 441 | 1 |
| Salisbury, CT | $43.77 | $0.00 – $50.58 | 440 | 4 |
| Larchwood, IA | $32.52 | $32.52 – $32.52 | 440 | 1 |
| Teller, AK | $397.45 | $383.44 – $439.67 | 440 | 5 |
| Veguita, NM | $141.38 | $141.38 – $141.38 | 439 | 1 |
| Palmas Del Mar, Humacao, PR | $73.58 | $73.58 – $73.58 | 439 | 1 |
| Edwards Afb, CA | $62.57 | $62.57 – $62.57 | 438 | 1 |
| Sloatsburg, NY | $53.41 | $53.41 – $53.41 | 438 | 1 |
| North Oaks, MN | $49.77 | $25.63 – $66.55 | 438 | 3 |
| Shawnee-On-Delaware, PA | $48.94 | $48.94 – $48.94 | 438 | 1 |
| Hawley, MN | $41.37 | $41.16 – $42.03 | 436 | 2 |
| Athol, ID | $64.79 | $56.36 – $77.10 | 435 | 3 |
| Inverness, MS | $11.20 | $11.20 – $11.20 | 435 | 1 |
| Long View, NC | $48.63 | $48.63 – $48.63 | 434 | 1 |
| Cape Gerardeau, MO | $57.41 | $57.41 – $57.41 | 432 | 1 |
| Barneveld, WI | $29.03 | $25.79 – $30.06 | 432 | 2 |
| Schuylerville, NY | $60.07 | $60.07 – $60.07 | 432 | 1 |
| Siren, WI | $8.51 | $8.51 – $8.51 | 431 | 1 |
| Moreaville, LA | $0.80 | $0.80 – $0.80 | 431 | 1 |
| Elberta, AL | $67.85 | $62.99 – $81.18 | 431 | 3 |
| Ashville, NC | $54.59 | $52.73 – $77.04 | 431 | 2 |
| Angola, NY | $70.71 | $70.71 – $70.71 | 430 | 1 |
| Lake Wylie, SC | $71.54 | $71.54 – $71.54 | 430 | 1 |
| Little Chute, WI | $28.78 | $12.91 – $31.58 | 430 | 4 |
| Mt Carmel, PA | $47.09 | $8.49 – $51.39 | 429 | 2 |
| Whitakers, NC | $3.04 | $0.00 – $11.07 | 429 | 3 |
| Prairie Grove, AR | $21.73 | $14.40 – $31.76 | 429 | 3 |
| Lake Mills, IA | $45.60 | $45.60 – $45.60 | 428 | 1 |
| Jb Pearl Harbor Hickam, HI | $226.01 | $226.01 – $226.01 | 428 | 1 |
| Bethlhem, PA | $46.88 | $46.88 – $46.88 | 428 | 1 |
| View Park, CA | $41.47 | $41.47 – $41.47 | 428 | 1 |
| Lafayette, NJ | $43.83 | $34.32 – $46.02 | 427 | 2 |
| Jewell, IA | $0.20 | $0.20 – $0.20 | 426 | 1 |
| Calipatria, CA | $1.46 | $1.46 – $1.46 | 425 | 1 |
| Lettsworth, LA | $0.00 | $0.00 – $0.00 | 424 | 1 |
| Johnson Cithy, TN | $36.04 | $36.04 – $36.04 | 424 | 1 |
| Hamilton City, CA | $2.50 | $2.50 – $2.50 | 424 | 1 |
| East Quogue, NY | $58.77 | $58.77 – $58.77 | 423 | 1 |
| Weston, CT | $66.67 | $66.67 – $66.67 | 423 | 1 |
| Glen Bunie, MD | $96.09 | $96.09 – $96.09 | 423 | 1 |
| Utica, NE | $104.43 | $96.89 – $131.17 | 423 | 2 |
| Paraje, NM | $28.86 | $28.86 – $28.86 | 422 | 1 |
| Houston, MN | $55.27 | $55.27 – $55.27 | 422 | 1 |
| Tewsbury, MA | $35.77 | $35.77 – $35.77 | 422 | 1 |
| La Cross, WI | $23.10 | $23.10 – $23.10 | 421 | 1 |
| San Juan Capo, CA | $89.99 | $89.99 – $89.99 | 421 | 1 |
| Lake Park, MN | $111.60 | $111.60 – $111.60 | 421 | 1 |
| Bayamom, PR | $70.16 | $70.16 – $70.16 | 420 | 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.