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 |
|---|---|---|---|---|
| Uhrichsville, OH | $30.56 | $30.56 – $30.56 | 420 | 1 |
| Lacona, NY | $63.62 | $63.62 – $63.62 | 419 | 1 |
| Bridgman, MI | $79.69 | $61.20 – $86.44 | 419 | 2 |
| Humeston, IA | $0.00 | $0.00 – $0.00 | 419 | 1 |
| Highland Hills, OH | $50.99 | $42.66 – $117.67 | 419 | 4 |
| Homerville, GA | $36.37 | $36.37 – $36.37 | 419 | 1 |
| Mesilla, NM | $168.05 | $168.05 – $168.05 | 417 | 1 |
| Fowler, IN | $57.05 | $57.05 – $57.05 | 415 | 1 |
| West Milton, OH | $38.34 | $32.56 – $42.73 | 415 | 2 |
| Haxton, CO | $77.92 | $77.92 – $77.92 | 415 | 1 |
| Knox City, TX | $8.30 | $6.75 – $14.87 | 415 | 2 |
| Fern Park, FL | $23.20 | $0.51 – $70.67 | 414 | 4 |
| Yates City, IL | $48.76 | $48.76 – $48.76 | 414 | 1 |
| Wernersville, PA | $51.28 | $51.28 – $51.28 | 413 | 1 |
| Hanover, KS | $132.12 | $19.23 – $144.90 | 413 | 2 |
| Meddybemps, ME | $77.45 | $77.45 – $77.45 | 413 | 1 |
| Nichols Hills, OK | $101.73 | $101.73 – $101.73 | 413 | 1 |
| Hiauatha, KS | $42.49 | $42.49 – $42.49 | 413 | 1 |
| Auburn, KS | $23.10 | $7.80 – $27.37 | 413 | 2 |
| Mosine, WI | $26.38 | $26.38 – $26.38 | 412 | 1 |
| Ottoville, OH | $34.61 | $34.34 – $34.98 | 412 | 2 |
| Fishertown, PA | $52.39 | $49.41 – $54.36 | 411 | 2 |
| Farmingon, CT | $20.09 | $20.09 – $20.09 | 410 | 1 |
| Beaver Island, MI | $0.39 | $0.39 – $0.39 | 410 | 1 |
| Milledgeville, IL | $49.52 | $49.52 – $49.52 | 409 | 1 |
| Tampa, DC | $4.26 | $4.26 – $4.26 | 407 | 1 |
| E Sandwich, MA | $56.95 | $15.39 – $59.56 | 406 | 2 |
| Quinton, OK | $647.64 | $647.64 – $647.64 | 406 | 1 |
| Groveton, TX | $21.44 | $21.44 – $21.44 | 406 | 1 |
| Meriden, KS | $26.42 | $26.27 – $31.45 | 405 | 2 |
| Leclaire, IA | $29.82 | $0.00 – $33.56 | 404 | 2 |
| Eagle Bend, MN | $319.71 | $319.71 – $319.71 | 404 | 1 |
| Steams, KY | $48.20 | $48.20 – $48.20 | 404 | 1 |
| Garder, MA | $14.05 | $14.05 – $14.05 | 404 | 1 |
| Loon Lake, WA | $29.58 | $18.36 – $41.67 | 401 | 2 |
| Sutherland, VA | $48.84 | $48.46 – $51.81 | 401 | 2 |
| Teterboro, NJ | $50.64 | $48.74 – $107.46 | 401 | 2 |
| Clancy, MT | $33.25 | $18.29 – $34.87 | 400 | 2 |
| Cherokee, KS | $73.94 | $73.94 – $73.94 | 400 | 1 |
| Rapid City, MI | $51.69 | $51.69 – $51.69 | 399 | 1 |
| Joseph, OR | $54.47 | $54.47 – $54.47 | 399 | 1 |
| Cato, NY | $69.67 | $47.83 – $73.39 | 399 | 2 |
| Cimarron, KS | $22.65 | $22.65 – $22.65 | 399 | 1 |
| Manchester, GA | $11.42 | $10.75 – $31.31 | 398 | 2 |
| West Wendover, NV | $1.71 | $1.71 – $1.71 | 397 | 1 |
| Buffalo, IA | $37.43 | $37.43 – $37.43 | 397 | 1 |
| North Jackson, OH | $43.72 | $40.16 – $54.97 | 396 | 3 |
| Robertson, WY | $54.33 | $54.33 – $54.33 | 396 | 1 |
| Cascade, MD | $58.20 | $54.04 – $117.43 | 396 | 2 |
| Barnstable, MA | $30.23 | $30.23 – $30.23 | 396 | 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.